Medications for the PTCB

Allergies

Allergies Allergies occur when your immune system reacts to a foreign substance — such as pollen, bee venom or pet dander — or a food that doesn't cause a reaction in most people

1.8Narrow therapeutic index (NTI) medications

Narrow therapeutic index drugs are drugs where small differences in dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions that are life-threatening or result in persistent or significant disability or incapacity Description. Narrow therapeutic index (NTI) drugs are defined as those drugs where small differences in dose or blood concentration may lead to dose and blood concentration dependent, serious therapeutic failures or adverse drug reactions. Serious events are those which are persistent, irreversible, slowly reversible, or life-threatening, possibly resulting in hospitalization, disability, or even death.

dietary supplement

dietary supplement is a manufactured product intended to supplement the diet when taken by mouth as a pill, capsule, tablet, or liquid

classifications of drugs

(stimulants, depressants, hallucinogens, narcotics)How Are Drugs Classified? Stimulants. Depressants. Hallucinogens. Dissociative. Opioids. Inhalants. Cannabis. Here are the five main categories and some information about each: Central nervous system depressants. Central nervous system stimulants. Opiates and Opiodes. Hallucinogens. Marijuana.

Acetaminophen and Alcohol

. Acetaminophen and Alcohol The over-the-counter pain reliever acetaminophen (Tylenol) and alcohol don't mix."Two or more alcoholic drinks per day can increase the liver toxicity of Tylenol," says Zive. "This toxicity can happen even if a patient takes less than the maximum 4 grams, or eight tablets, of Tylenol per day." This interaction can be especially problematic in older adults, says Zive, since the liver's ability to diminish drugs decreases with age. "The liver of a 65 year old doesn't function the same way it did at age 25," he says.

1.10Proper storage of medications (e.g., temperature ranges, light sensitivity, restricted access

1.10Proper storage of medications (e.g., temperature ranges, light sensitivity, restricted access

SEE PTCB BOOK PAGE 27

1.5Common and severe medication side effects, adverse effects, and allergies

Common and life-threatening drug interactions and contraindications (e.g., drug-disease, A drug-disease interaction happens when a drug that was prescribed for therapeutic use causes harmful effects in a patient because of a disease that the patient already has. Such diseases alter the body's ability to metabolize, or break down, a drug, drug-dietary supplement, drug-laboratory, drug-nutrient)

A drug interaction is a change in the action or side effects of a drug caused by concomitant administration with a food, beverage, supplement, or another drug. There are many causes of drug interactions. For example, one drug may alter the pharmacokinetics of another.

Drug Disease

A drug-disease interaction happens when a drug that was prescribed for therapeutic use causes harmful effects in a patient because of a disease that the patient already has. Such diseases alter the body's ability to metabolize, or break down, a drug

drug disease

A drug-disease interaction is an event in which a drug that is intended for therapeutic use causes some harmful effects in a patient because of a disease or condition that the patient has. There are some diseases that alter the body's ability to metabolize, or break down, a drug so that it can have the intended effect.

Drug classification

A method of grouping drugs; may be based on structure or therapeutic use.. A drug class is a term used to describe medications that are grouped together because of their similarity. There are three dominant methods of classifying these groups:1 By their mechanism of action, meaning the specific biochemical reaction that occurs when you take a drug(see drug classification set)

drug-lab interactions

ATOPIC DERMATITIS / ECZEMA Scientists demonstrate how genetic variations cause eczema MedicalXpress Breaking News-and-Events INFECTIOUS DISEASES Common drugs that can interfere with lab tests John Murphy, MDLinx|November 11, 2019 Last week, the FDA issued a warning that biotin, often found in dietary supplements, can cause clinically significant incorrect results on lab tests. The FDA was particularly concerned about troponin-based lab assays used to diagnose heart attacks. In these tests, biotin can cause falsely low results, leading to missed diagnoses and potentially serious clinical implications. Lab tests are essential for diagnosis and treatment—but what happens when a drug affects a lab test's results? Also known as vitamin B7, biotin is found in multivitamins (including prenatal multivitamins),B-complex vitamins, and dietary supplements. Many supplements promoted for hair, skin, and nail growth contain biotin levels up to 650 times the recommended daily intake (which is 0.03 mg). Patients with conditions such as multiple sclerosis may also take high levels of biotin, as directed by their physicians. Biotin can also interfere with hormone lab tests, causing falsely high results in testosterone, estradiol, cortisol, free triiodothyronine (T3), and free thyroxine (T4) levels, and falsely low results in thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone, parathyroid hormone, and human chorionic gonadotropin levels. This recent news serves as a reminder that many prescription and over-the-counter drugs, as well as dietary supplements, can affect lab test results. It's an important reminder, considering that an estimated 70% of medical decisions made in the United States are based on results from clinical lab tests. In 2006 alone, Medicare reimbursed more than $2 billion just for four clinical tests: complete blood count, comprehensive metabolic panel, TSH assay, and routine lipid panel. [interrupt] Because incorrect test results can lead to unknown diagnoses and treatment errors that may harm patients, it's important for clinicians to take a careful medical history, as well as to know which drugs can affect which tests. It's important to be aware that the three drug categories that most interfere with lab tests are also highly common ones: antibacterials, psychotropics, and contrast media. To that end, here's a summary of common drugs and supplements and the lab tests that they interfere with. Antibacterials Antibacterial agents are the drugs most likely to interfere with laboratory tests, with cephalosporins at the forefront. Cephalosporins can cause false positive results in urine glucose and urine ketone tests, as well as in the direct Coombs test (used to detect immune-mediated hemolytic anemia). Penicillin-type antibiotics like amoxicillin and ampicillin can also cause falsely elevated glucose test results. In addition, co-trimoxazole, daptomycin, erythromycin, and telavancin can cause falsely elevated results in prothrombin time (PT) and the international normalized ratio (INR). Doxycycline can cause falsely elevated results in catecholamine tests. Levofloxacin, ofloxacin, and rifampin can cause false positives in urine drug screenings for opiates. Ciprofloxacin can mildly elevate results in urine protein tests. Psychotropics Psychotropic drugs, which include antidepressants, antipsychotics, and anti-dyskinesia agents, can cause false positives in drug screens and in pregnancy tests. Contrast media Iodinated contrast media can affect protein levels in the blood, which can manifest as falsely increased results in protein blood tests or protein urine tests. Gadolinium contrast agents can falsely decrease results in colorimetric assays for serum angiotensin-converting enzyme, calcium, and zinc. These agents can also cause positive interference in creatinine, magnesium, selenium, and total iron binding capacity assays, and both positive and negative interference in iron assays. After contrast media are administered, patients should wait at least 4 hours before having lab specimens collected. Proton pump inhibitors Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, dexlansoprazole, rabeprazole, pantoprazole, and esomeprazole can cause false negatives in the urea breath test and the stool antigen test. With long-term use, PPIs can lead to false positives in the urea breath test. Some clinicians have reported increased INR and PT in patients receiving PPIs and warfarin concomitantly. PPIs can also cause elevated serum levels of chromogranin A, a marker for tumors. Biotin In addition to its effects on troponin-based lab assays and hormone tests, biotin may also cause results of falsely high levels of IgE and falsely low levels of insulin, autoantibodies, vitamin B12, vitamin D, folate, prostate-specific antigen, carcinoembryonic antigen, thyroglobulin, ferritin, DHEA-S, IgM, and hepatitis A, B, and C antibodies. Acetaminophen Acetaminophen may cause falsely high readings on some continuous glucose monitors. Amiodarone Amiodarone may cause increases in PT and INR. Chloroquine and quinine Chloroquine and quinine may cause an increase in protein urine results. Gabapentin Gabapentin may cause an increase in protein urine results. [interrupt] NSAIDs NSAIDs may cause increases in PT and INR. Niacin Niacin may cause an increase in catecholamine results. Propranolol Propranolol may cause increases in PT and INR. St. John's wort St. John's wort may cause decreases in theophylline and digoxin. "Medical professionals, clinicians and laboratory staff should keep these possible interactions in mind when interpreting the results of laboratory tests, and should ensure that they obtain a complete and accurate record of all drugs being used by patients in order to anticipate potential [drug-laboratory test interactions]," wrote the authors of a systematic review on the subject. They also called for a reporting system to address potential interactions between drugs and laboratory tests. But until such a system is available, physicians can report such interactions to the FDA through MedWatch. MORE:

adverse effects

Adverse effect adverse effect. Abnormal, harmful, or undesirable effect on an organism that causes anatomical or functional damage, irreversible physical changes, or increases the susceptibility to other biological, chemical, or environmental stresses.

Antibiotics and Dairy ProductsDairy products

Antibiotics and Dairy ProductsDairy products such as milk, yogurt, and cheese can delay or prevent the absorption of antibiotics such as tetracyclines and ciprofloxacin (Cipro). This occurs because the calcium in such foods binds to the antibiotics in the stomach and upper small intestine to form an insoluble compound. To avoid problems, Zive recommends taking an antibiotic one hour before or two hours after a meal. However, there's no need to avoid milk and dairy with all antibiotics. For example, it's recommended that metronidazole (Flagyl) should be taken with water or milk to prevent stomach upset

Antithyroid Drugs and Iodine-Rich FoodsAntithyroid

Antithyroid Drugs and Iodine-Rich FoodsAntithyroid drugs are compounds that interfere with the body's production of thyroid hormones, thereby reducing the symptoms of hyperthyroidism. According to a broad body of research, Americans' high-iodine diets account for the lower remission rate of hyperthyroidism in those who are prescribed antithyroid drugs. Antithyroid drugs work by preventing iodine absorption in the stomach. A high-iodine diet requires higher doses of antithyroid drugs. The higher the dose of antithyroid drugs, the greater the incidence of side effects that include rashes, hives, and liver disease. The richest dietary sources of iodine are seafood and seaweed, such as kelp and nori. Iodine is also found in iodized salt and to a lesser extent in eggs, meat, and dairy product

Bromocriptine(Dopamine promoter It can treat menstrual problems, growth hormone overproduction, Parkinson's disease, and pituitary tumors. It can also stop breast milk production. In addition, this medication can help control blood sugar levels in patients with type 2 diabetes) and Pseudoephedrine(Decongestant It can treat stuffy nose and sinuses.)

Bromocriptine and Pseudoephedrine The interaction can lead to severe peripheral vasoconstriction, ventricular tachycardia, seizures, and possibly death.(5,13)Bromocriptine is an ergot-derived dopamine agonist with several uses, including antiparkinsonian therapy. New treatment guidelines for Parkinson?s disease recommend a first-line therapy change from levodopa to bromocriptine or other dopamine agonists, such as ropinirole, pramipexole, or pergolide.(14)Notable side effects of bromocriptine include thickening of bronchial secretions and nasal congestion.(11)This is significant because it increases the likelihood of a patient taking bromocriptine to self-medicate with an OTC decongestant such as pseudoephedrine. Patients receiving bromocriptine should be advised to avoid all sympathomime-tics.(5)

Calcium Channel Blockers and GrapefruitCalcium

Calcium Channel Blockers and GrapefruitCalcium channel blockers are prescribed for high blood pressure. A natural element found in grapefruit latches onto the intestinal enzyme called CYP3A4, which alters the breakdown of the calcium channel blockers, possibly resulting in excessively high blood levels of the drug, along with an increased risk of serious side effects. It doesn't take a jumbo serving of grapefruit to produce a deleterious effect either. For example, a single 6-ounce glass of juice can reduce levels of CYP3A4 by nearly 50%. This effect dissipates slowly. One study indicated that one third of the impact on CYP3A4 from grapefruit juice was still evident a full 24 hours later. The interaction between grapefruit and calcium channel blockers is strongest, for example, with felodipine (Plendil), nicardipine (Cardene), and nisoldipine (Sular) and weaker with amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Adalat). Tangelos, a cross between a tangerine and grapefruitlike pomelo and Seville oranges, a bitter citrus fruit used to make marmalades, can have the same deleterious effects as grapefruit on both statins and calcium channel blockers.

CapletA

CapletA Caplet is an oval-shaped tablet.

Capsules

CapsulesTo form a Capsule the drug is contained in a cylindrically shaped shell, which breaks open and the drug is released. This includes gelatin capsules.

Drug-Food-Herbal Interactions

Coenzyme Q10 CoenzymeQ10, also known as ubiquinone or CoQ10, is found naturally in the heart, kidney, liver and pancrease, but aging and smoking can deplete these natural stores. CoQ10 is promoted to help heart damage caused by certain cancer medicines and for breast cancer, gum disease, or muscular dystrophy, although robust studies confirming these uses are lacking. However, use of CoQ10 with anticoagulant drugs like warfarin may decrease the blood thinning effects of the anticoagulant and increase the risk for a clot. If you are considering the use of any supplement, always check with your doctor first. And if you take a blood thinner, check with your doctor before starting CoQ-10. You may need to have your blood clotting tests checked more frequently and may need a change in your anticoagulant dose. Cranberry Even the simple, delicious cranberry can have drug interactions. Cranberries are a fruit chock full of vitamin C, and some people drink cranberry juice to help prevent urinary tract infections (UTI). Although data is conflicting, some studies have shown cranberry can reduce recurrent UTIs in pregnant women, the elderly and hospitalized patients; but it is not helpful to cure a UTI. Cranberry may exert an increased effect on blood thinners (anticoagulants) like warfarin and lead to bruising or bleeding. If you take an oral blood thinner, check with your doctor before consuming unusual amounts of cranberry or cranberry juice. You may need to have your International Normalized Ratio (INR) or other blood clotting lab test checked more frequently. Echinacea Echinacea is also known as the American Cone Flower, Black Susan, or Purple Coneflower. Echinacea has been used to stimulate the immune system, and is most commonly used in the treatment of the common cold. Most echinacea drug interactions are not serious; however, it can affect blood levels of drugs like tizanidine (Zanaflex), a muscle relaxant or rasagiline (Azilect) used in Parkinspn's disease. Echinacea can slow the breakdown (metabolism) of caffeine in your body, and could lead to side effects like jitteriness, headache, or insomnia. Echinacea may also change how the body metabolizes many drugs that go through the liver. These are somewhat complicated interactions that can lead to side effects or reduced effectiveness of your medicine, so always check with your pharmacist. Evening Primrose Oil Evening primrose is a flowering plant known by other names such as Oenothera biennis, scabish, or king's cureall. Evening primrose oil provides fatty acids used by the body for growth. Evening primrose oil contains gamma linoleic acid that may slow blood clotting and increase the likelihood of brusing or bleeding. If you take drugs or herbs that may have blood thinner effects (for example: warfarin), check with your health care provider before using evening primrose oil. Prompty report any signs of bleeding to your doctor if these agents are combined. Use of evening primrose oil may increase the risk for seizures if you take anti-seizure medications or phenothiazine drugs, although data regarding the effect of gamma linolenic acid on seizure threshold are conflicting and limited. You can check for other evening primrose oil drug interactions here. Valerian Valerian has been used to treat insomnia and anxiety, although evidence is conflicting on how well it works. Germany's Commission E, the authorities that evaluate the use of herbal products in Germany, has approved valerian as an effective mild sedative. There are over 200 possible drug interactions with valerian, so a drug interaction screen is important when using valerian. Speak with your doctor before combining valerian with: muscle relaxants sleep or anxiety medicines pain killers antidepressants or other medicines that cause drowsiness. These drugs may increase drowsiness and dizziness while you are taking valerian. St. John's Wort St. John's Wort is a popular herbal supplement widely used to help with symptoms of depression. Over 500 drug interactions exist with St. John's Wort and some can be dangerous. Due to the seriousness of many drug interactions, you should consult with your health care provider before using St. John's Wort. A sampling of drugs you should not combine with St. John's Wort includes: selective serotonin reuptake inhibitors (SSRIs) tricyclic antidepressants (TCAs) monoamine oxidase (MAO) Inhibitors nefazodone triptans for migraine warfarin birth control pills or other estrogens certain HIV medications and Hepatitis C Virus (HCV) drug treatments There are many other possible interactions. Check with your doctor or pharmacist for a drug interaction screen with St. John's Wort if you take prescription, OTC, vitamin or other herbal medications. Saw Palmetto Use of saw palmetto is popular for benign prostatic hypertrophy (BPH), a noncancerous prostate gland enlargement. Evidence suggests that saw palmetto may be effective for mild-to-moderate BPH, but always ask your doctor for advice about this product. Saw palmetto should be avoided with other agents used to treat BPH, such as finasteride (Proscar), unless okayed by your doctor. There are over 20 listed interactions with saw palmetto, but most of these are minor interactions. If saw palmetto is combined with estrogens or oral contraceptives, the effectiveness of the hormonal therapies could be reduced. The tannic acid present in some herbs like saw palmetto may inhibit the absorption of iron. The administration of these herbs and iron-containing supplements should be separated by several hours. Check with your doctor or pharmacist for a drug interaction screen. Melatonin Melatonin is a natural hormone that helps to regulate the sleep-wake cycle. For some people, melatonin tablets may be helpful for insomnia, jet lag and shift work sleep disorders. However, because melatonin causes drowsiness, its use should be avoided with alcohol and other sedating medicines, such as: benzodiazepines sedatives and hypnotics some antihistamines opioid analgesics muscle relaxers. Other herbs that can also lead to drowsiness include 5-HTP, kava, and St. John's Wort. As with many herbal products, blood clotting may be affected with use of melatonin with anticoagulants such as warfarin. Related: Melatonin: Worth Losing Sleep Over? Kava Kava, native to the South Pacific, is a member of the pepper family. Kava has been used to improve sleep, decrease anxiety, and tame nervousness, stress, and restlessness. Talk to your doctor before using kava. There are over 200 drug interactions with kava. Kava should not be used with alcohol or other drugs or herbs that can also cause liver toxicity. The use of buprenorphine (Buprenex, Butrans, Probuphine) with kava can lead to serious side effects such as respiratory distress, coma or even death. Products containing kava may cause liver problems, and taking them with alcohol can increase the risk. Call your doctor immediately if you have fever, joint pain, bleeding, skin rash or itch, appetite loss, fatigue, nausea/vomiting, stomach pain, dark colored urine, light colored stools, and/or yellowing of the skin/eyes; these may be signs of liver toxicity. Ginseng Ginseng has been used in Asian countries for its therapeutic effects for centuries. Today, ginseng use is reported to improve the body's resistance to stress and increase vitality, among other uses. There are many different origins of ginseng, and many types of drug interactions. Long-term use of American ginseng may decrease the effectiveness of warfarin, a blood thinner, and increase the risk for a blood clot. In general, ginseng or ginseng-containing herbal tea should not be used with anticoagulants. Ask your doctor about this interaction. Ginseng may also affect blood pressure treatments and diabetic medications like insulin or oral hypoglycemics. Be sure to check with your pharmacist or doctor if you use ginseng as an herbal supplement. While usually well-tolerated, important drug interactions can occur. Yohimbe Yohimbe is the name of an evergreen tree that is found in some African countries. The bark of yohimbe contains a chemical called yohimbine. Yohimbine can dilate blood vessels and is often promoted for erectile dysfunction (ED) or sexual problems caused by selective serotonin reuptake inhibitors (SSRI) antidepressants. It's important at least 14 days should elapse between discontinuation of MAOI therapy, an infrequently used treatment for depression, and initiation of treatment with yohimbine. MAOIs are typically only used when other antidepressants have proven ineffective, because they have a higher risk of drug interactions than standard antidepressants and can also have interactions with certain foods such as aged cheeses and cured meats. Therapy with yohimbine is generally not recommended in patients with hypertension, angina, or heart disease because it has a stimulatory effect and can lead to high blood pressure and a rapid heart rate. You can check other yohimbine interactions here. Discuss the use of this supplement with your doctor to be safe. Feverfew Feverfew is a member of the daisy family. Feverfew is often used as an herbal remedy to prevent migraine headaches and associated nausea and vomiting; however, the evidence is not conclusive. Alarmingly, feverfew may increase the risk of bleeding, especially in people with blood-clotting disorders or using blood thinners to help prevent clots, for example: aspirin warfarin heparin Plavix (clopidogrel) Pradaxa (dabigatran) Xarelto (rivaroxaban) low molecular weight heparins like enoxaparin or dalteparin. Check with your health care provider before using feverfew; you can check for other drug interactions with feverfew here. Ginkgo Biloba The use of ginkgo extract dates back centuries in traditional Chinese medicine. Ginkgo interacts with over 260 drugs; have a pharmacist check for interactions before use. Ginkgo has been used for treating anxiety, dementia, circulation problems in the legs, premenstrual sydrome, certain vision problems, dizziness), or some movement disorders. Research has shown that Ginkgo Biloba is not likely to be effective in treating heart disease. Ginkgo may decrease antiviral effects of drugs used in HIV, such as efavirenz. Avoid ginkgo in patients who take seizure medications and blood thinners. Goldenseal Goldenseal is a flowering herb that grows in the northeast United States. Common uses for goldenseal include skin infections, for cold and flu symptoms, and to treat diarrhea, but evidence is weak for these uses. There are over 90 possible drug interactions with goldenseal, have your pharmacist check for drug interactions with all your medicines. Two of the more serious interactions occur with certain antipsychotic drugs - using pimozide or thioridazine with goldenseal is not recommended, as antipsychotic blood levels may rise leading to an irregular heart rhythm. Goldenseal may affect liver enzymes that can alter blood levels of certain drugs; always have your pharmacist run a drug interaction screen on all of your medicines, OTC drugs, or herbs. Garlic Garlic is a commonly used - and loved - flavoring agent, food product and herbal supplement. There are many conditions garlic has been promoted for - to reduce cholesterol and triglycerides, to prevent cancer, to lower blood sugar levels, and to reduce menstrual pain, among other uses. There are over 180 drug interactions with garlic, but most are reported as minor. Garlic has been reported to moderately affect blood clotting and blood sugar levels and may affect people who take blood thinning agents like aspirin, warfarin, or clopidogrel (Plavix). Use of garlic supplements with HIV protease inhibitors (PI) may decrease the PI blood levels. There are other possible garlic interactions, so be sure to review all possible drug interactions with garlic and speak with your healthcare provider. Green Tea Green tea is a popular drink that originated in China and has been promoted for stomach disorders, to lower cholesterol, as an anti-cancer antioxidant, as a stimulant, and to lessen belly fat, among other uses. In the U.S., it has gained recent popularity due to claims it can boost metabolism and aid in weight loss. Only 3 minor drug interactions have been reported with green tea. Dried green tea leaves contain vitamin K, which can increase blood clotting. Large amounts of vitamin K may interfere with the activity of some blood thinners. A substantial decrease in the INR (a measure of blood clotting) has been reported in a patient treated with warfarin after he began consuming large quantities (1/2 to 1 gallon daily) of green tea. Patients treated with warfarin should probably avoid large amounts of green tea as it can interfere with the blood-thinning capabilities of warfarin. Ginger Ginger is a commonly used flavoring agent, food product, and herbal supplement. Ginger has been used in the treatment and prevention of motion sickness, vertigo, to increase appetite, and to reduce stomach acidity. Ginger has also been used by some women under medical supervision to reduce severe nausea and vomiting in pregnancy. Over 50 drug interactions are reported with ginger. Drug interactions with ginger are not well documented; however, it is known to inhibit thromboxane synthetase, which can prolong bleeding time and may cause interactions with anticoagulants like warfarin, aspirin, or other blood thinners. Check other possible ginger-drug interactions here. Always check with yourt doctor or pharmacist to check for herbal and drug interactions. Black cohosh is a shrub-like plant found in North America. Black cohosh is often used for menopausal disorders ("hot flashes"), painful menstruation, uterine spasms, and vaginitis. However, prescription drugs broken down by certain liver enzymes may accumulate in the body and lead to toxicity if used with black cohosh. There is concern that black cohosh might also be toxic to the liver and may enhance liver toxicity with certain medications, such as: atorvastatin (Lipitor) acetaminophen (Tylenol) alcohol Let's face it, dr

ompounded Nonsterile Preparations

Compounded Nonsterile Preparations: A preparation intended to be nonsterile created by combining, admixing, diluting, pooling, reconstituting other than as provided in the manufacturer's labeling, or otherwise altering of a drug or bulk drug substance.

Digoxin, High-Fiber Diets, and HerbsDigoxin (Digitalis, Digitek, Lanoxin)

Digoxin, High-Fiber Diets, and HerbsDigoxin (Digitalis, Digitek, Lanoxin) is used to strengthen the contraction of the heart muscle, slow the heart rate, and promote the elimination of fluid from body tissues. Dietary fiber, specifically insoluble fiber such as wheat bran, can slow down the absorption of digoxin and lessen its effectiveness. To prevent this, elders should take digoxin at least one hour before or two hours after eating a meal. Herb use can also affect digoxin. For example, ginseng can elevate blood levels of digoxin by as much as 75%, while St. John's Wort decreases blood levels of this drug by 25%. "It's important for the patient to recognize signs of digoxin toxicity," says Zive. "These include a yellow tint to vision and the appearance of halos around objects, as well as weakness, confusion, dizziness, and nausea and vomiting."

dosage form

Dosage form Description Description Dosage forms are pharmaceutical drug products in the form in which they are marketed for use, with a specific mixture of active ingredients and inactive components, in a particular configuration, and apportioned into a particular dos

1.6Indications of medications and dietary supplements

Drug indications are those diseases, signs and symptoms that may be treated by using a specific drug. A drug indication does not suggest complete resolution, total relief or a cure from using the drug but is based on success achieved in clinical trials. For example : Paracetamol is indicated for pain and fever

Duration of Drug Therapy

Drug therapy, also called pharmacotherapy, very broadly refers to the use of substances other than food (drugs/medications) for the prevention, diagnosis, or treatment of a medical condition (as well as its signs and symptoms). Most often, this term is used with respect to treatment.The duration of drug therapy is determined by the diagnosis and other patient-specific factors. Chronic conditions, like depression or diabetes, may require ongoing medication treatment. More acute problems, like pain or an infection, may just need to be treated for a few days or weeks.

Drug-Dietary Supplement Interactions/Drug food interactions

Drug-Nutrient Interactions Adrug-nutrientinteractionis a reaction between a medicine and one or more nutrients. Nutrients are thevitaminsand minerals that are in the food you eat.Vitaminsand minerals nourish your body, help keep you healthy, and reduce your risk for chronic diseases

Elixirs

ElixirsElixirs contain between 5% and 40% alcohol.

Emulsions

EmulsionsAn Emulsion is a suspension involving one liquid in a second liquid with which the first will not mix. (oil in water or water in oil)

Enemas

EnemasDrug is suspended in a solution and infused into the rectum.

Enteral medications

Enteral medications are given orally and pass through the GI tract to be absorbed into the bloodstream and metabolized by the liver. This includes oral, naso-gastric, and rectal routes.

Erectile Dysfunction Drugs and Grapefruit

Erectile Dysfunction Drugs and Grapefruit Although unproven, evidence points to the likely fact that grapefruit juice gives a boost to blood levels of erectile dysfunction drugs such as sildenafil (Viagra). This may seem like a boon to some men, but it could trigger headaches symptomatic of fatal or near fatal conditions, flushing, or low blood pressure.

Drug food interactions

Food is known to increase, decrease, or delay drug absorption. Food can bind with drugs, causing less or slower drug absorption.

Inhalation routes of administration

Inhalation routes of administration are inhaled through the mouth or the nose and usually act directly on the respiratory system before entering into the bloodstream. They are often used to treat respiratory diseases, but gases are inhaled for general anesthesia as well

InhalationInhaled

InhalationInhaled through the mouth or nose and usually act directly on the respiratory system before entering into the bloodstream. They are often used to treat respiratory diseases, but gases are inhaled for general anesthesia as well

Injectable drugs

Injectable drugs are usually in the form of solutions or powders, which are mixed with a sterile diluent to render an injectable solution.

Insulin, Oral Diabetic Agents, and Alcohol

Insulin, Oral Diabetic Agents, and Alcohol An alcoholic drink can increase or prolong the effects of insulin or oral diabetic agents (pills) and thus lead to hypoglycemia or low blood sugar. The glucose-lowering action of alcohol can last as long as eight to 12 hours. Symptoms of hypoglycemia include nervousness, sweating, trembling, intense hunger, weakness, palpitations, confusion, drowsiness, and ultimately coma. With a doctor's approval, and in the absence of other health conditions such as pancreatitis, elevated triglycerides, and neuropathy, older adults with diabetes may be able to enjoy up to two drinks per day. A drink is defined by the American Diabetes Association as a 12-ounce beer, a 5-ounce glass of wine, or 1.5 ounces of a distilled beverage such as whiskey, vodka, or gin. Individuals can reduce the risk of low blood sugar by having alcoholic drinks at mealtime or by having a snack along with the drink. In addition, certain oral diabetic medications such as chlorpropamide (Diabinese) can cause dizziness, flushing, and nausea when taken along with alcohol.

1.9Physical and chemical incompatibilities related to non-sterile compounding and reconstitution

List of Updates/ChangesNote: All of these changes should be incorporated into the pharmacy's standard operating procedures (SOPs) 1. Microbial contamination must be addressed 2. A Designated Person(s) must be named who is responsible and accountable for the performance and operation of the facility and personnel in the preparation of Compounded Nonsterile Preparations (CNSP) 3. Any mention of hazardous drugs is now contained in USP <800>4. Facilities: a. Storage area temperature MUST be monitored and recorded dailyb. Compounding Area MUST be specially designated for nonsterile compoundingc. If preparing any hazardous drug CNSPs that are listed in the National Institute for Occupational Safety and Health (NIOSH) compendia, then the facility design MUST be in an appropriate negative pressure segregated compounding room. (This will be discussed further in a future USP <800> review article.) 5. Cleaning and Sanitizing: All surfaces MUST be cleaned and sanitized a. Cleaning: The process of removing soil from objects and surfaces is accomplished by manually or mechanically using water with detergents or enzymatic products.b. Sanitizing: The process of reducing, on inanimate surfaces, the number of all forms of microbial life, including fungi, viruses and bacteria.c. Frequency: i. Work Surfaces: At the beginning and end of each shift, between compounding CNSPs or when spills occurii. Floors: No carpeting, daily or after any spillsiii. Walls: Every 3 months or after any spills or surface contaminationiv. Ceilings: When visibly soiled or surface contamination has occurredv. Storage Shelving: Every 3 months 6. Equipment: a. Weighing, measuring or manipulating components that could generate airborne chemical particles MUST be done in a closed system environment. i. Containment Ventilated Enclosure (CVE)ii. Biological Safety Cabinet (BSC)iii. Must be certified every 12 months 7. Components: a. Active Pharmaceutical Ingredients (API) MUST: i. Comply with USP-NF monographii. Present a Certificate of Analysis (COA)iii. Be obtained from an FDA registered facility 8. Beyond Use Dates (BUD) are the date, or the hour and date, beyond which the CNSP cannot be used and MUST be discarded a. Factors to Consider: i. Chemical and physical properties of the APIii. Compatibility of the container-closure systemiii. Degradation of the container-closure systemiv. Potential for MICROBIAL CONTAMINATION (NEW) b. Extending BUDs: i. MUST not exceed the BUD specified in USP-NF monographii. Aqueous and nonaqueous CNSPs may be extended to a maximum of 180 days but MUST have a stability study using a stability-indicating assay for the API, CNSP and type of container-closure that will be used

Lozenge and TrocheLozenges and Troches

Lozenge and TrocheLozenges and Troches are meant to be dissolved slowly in the mouth and generally have a local effect

MAOIs and Tyramine-Containing FoodsMonoamine

MAOIs and Tyramine-Containing FoodsMonoamine oxidase inhibitors are an older type of antidepressant still prescribed, albeit less frequently, due to their serious side effects. "Foods containing tyramines, such as some red wines, malt beer, smoked fish, aged cheeses, and dried fruits, can cause a hypertensive crisis or severe and dangerous elevation in blood pressure when taken with this class of antidepressants," says Zive.

Medication Reconstitution

Medication Reconstitution: Using the given directions, or recipe, on a prescription label to reconstitute the powder contained inside to a specific concentration as indicated. Reconstitution: The process of adding a diluent to a dry ingredient to make it a liquid.

1.10Proper storage of medications (e.g., temperature ranges, light sensitivity, restricted access

Medication Storage, Where, How, Temperatures, Types, and Guidelines Posted October 21, 2019 byMichael Chamberlain- SeeEditorial Guidelines Do you ever wonder what the best way to store that vital medication you need is? In this blog we are going to offer some crucial guidelines to follow in order to ensure proper medication storage. Prescription drugs come in many forms with different guidelines. We'll go over what you need to do to store them effectively. What is proper medication storage? Every medication has its own recommended storage condition from room temperature, to refrigerating, to freezing. The majority of medications are recommended to be stored at room temperature, between 59 to 77 degrees Fahrenheit. As a common rule, medications should be stored away from heat, air, light, and moisture. Apart from the storage place, climatic conditions should also be considered when storing. This is because the potency and the overall effectiveness of your medications depend on appropriate storage. Inappropriate storage can turn medications harmful if ingested. Now with that being said, let's take a look at a guide on storing medications. Medication Storing Temperatures The main information you need for storing medication is the recommended storing temperature. This is the first thing that will help you store your medication in an accurate place. Read the medication cover for storing temperatures or check with your pharmacist about it. Usually, the packages will specify the storage as to be stored at room temperature, cool temperature, refrigeration or freezing. If your medication has already frozen and shouldn't be, then check our guide on medication that has frozen. Room temperature specifies the temperature range between 59 to 77 degrees Fahrenheit, cool temperature between 46 to 59 degrees Fahrenheit, refrigeration temperature between 35.6 to 46 degrees Fahrenheit, and freezing temperature means -13 to 14 degrees Fahrenheit. The table below is a good quick reference guide. Medication Package Storing GuidelinesDegrees FahrenheitRoom Temperature59 to 77Cool Temperature46 to 59Refrigeration35.6 to 46Freezing-13 to 14 Medication Storage Places Depending on the temperature recommended you can use an appropriate place that fits the temperature range. Like I said the majority of the medications are recommended to be stored at room temperature. Such medications can be stored in a dresser drawer, a storage box, a closet, or even a shelf. Obviously, to chill the temperature you'll need it to be kept in a cool place, whereas refrigerating and freezing clearly require a refrigerator. As a general rule, most of the liquid medications are recommended to be stored in the fridge. Liquid formulations such as syrups and suspensions can support the growth of micro-organisms. So, the growth of these micro-organisms is inhibited by refrigerating. Especially liquid medications without preservatives - they should be refrigerated at all times. But when refrigerating make sure that meds are stored in an area within the fridge that can maintain a consistent temperature. When the meds include preservatives, it's not recommended to store them in the fridge. This is because the effectiveness of the preservatives increases with the temperature. So, when refrigerating these medications, the effectiveness is cut down. So, unless specified by the manufacturer or the pharmacists, never refrigerate medications that contain preservatives. One good example is Cetirizine oral solution that contains parabens as preservatives. Children's liquid medications significantly vary in the recommended storage conditions. Some liquids should be refrigerated like Cephalexin, while some should be stored at room temperature like Azithromycin and some others may have different expiration dates depending on which option is chosen - like Amoxicillin. So, it's very important to double-check the storage requirements with your pharmacist if you're not clear on the packaging guidelines. Apart from the recommendations discussed above, it's a good rule, in general, to always read the label and packaging thoroughly when you need to figure out the best storage for your medication. Storing Medications While Traveling Traveling is a part of life, but it's important to make sure your medications travel safely with you. It's not just about packing medications along with your clothes. Make sure you're carrying your medications in the appropriate storage conditions including the temperature wherever possible. Store any medications in the original package or label to avoid confusion. Also, be sure to carry a copy of the prescription, so it's easy for identification in case of an emergency. Combining Medications Never try to save luggage space by combining several medications in one container. Make sure your medications are stored in carry-on luggage so it's easy to take during emergencies. If you're planning for an extended trip around a humid/hot environment, consider placing silica packs in medications. When it comes to meds such as insulin and liquid antibiotic, you'll need special storage. This is because insulin is stable at room temperature only for 28-30 days. So, if your insulin has to extend beyond this minimum period then it has to be kept under refrigeration even while traveling. So, to meet this storage when traveling, you can make use of a thermos or a cooler. When you've reached the destination after traveling, you can then store it in the refrigerator. Although it all sounds like a hassle, being diligent about storing your medication safely and appropriately is essential to get the most out of your medications. While that's the basic storage guide, the following are some basic storage principles that have to be followed in any form of storage. Storing Medication in Humid Areas While it's a common belief that a bathroom cabinet is an ideal place for storing medication, in reality, it's not. This is because of the heat and humidity that a bathroom can generate. The bathroom door is likely to be closed most of the time, and the steam released from the shower may not keep your medication dry and cool - or at least - not at room temperature. This will contribute to your meds losing their efficiency. Storing Medication in Hot Areas The same effect as the bathroom conditions apply here. When medications are stored above the stove top or top of the fridge, the heat and light from these places can affect them. This means your medication will not stay as cool and dry as it's supposed to be most of the time. Again, reducing the overall effectiveness you should get from them. Out of Reach for Children and Pets Sounds obvious, but it's a must. You need to make sure any medications you store are not within reach of children or family pets. The best thing you can do here is to child lock your medication cabinet if there's any chance that young children or pets are likely to be around your home. Young curious minds can easily take something they can get to when it's easily accessible, even if they shouldn't. Categorize Your Medications You should be extremely careful in what you are storing the medications in. Rather than throwing all your medications in one random basket, categorize your medications. It's best to have separate or divided boxes for each of your meds. They should be carefully labeled or easily identifiable from one another. This will prevent you from mismanaging your medications, taking the wrong ones, and helps you in keeping an easy track of expiration dates. Check out our tips to organize and remember your medications. Review Medication Expiration Dates Checking your medication expiration dates is a crucial task in storing medications. You have to make sure you read, remove, and return medications appropriately. This means you check and remove unwanted medications that have reached expiration and return the medications to the local pharmacy for safe disposal. It might also be good to emphasize here, never flush your medications down the toilet, or release down a drain - it may seriously affect the water supply. You should make sure you review the expiration dates of your meds at least once a week. For this, again you have to make sure the medications are categorized properly so it's easy to review medication expiration dates. Check out our guide on checking medication expiration dates. Reviewing the Conditions of Stored Medication When reviewing medications make sure to check on the appearance of the medication. Medications that have changed color, consistency, or odor should never be used, regardless of the expiration date. At the same time, pills that tend to stick together and have an unusual texture, or if they look cracked or chipped, should also not be used. We hope this guide to storing your medications has been useful. If in doubt as to the effectiveness of any stored medication, or for professional medical guidance on med storage, consult your pharmacy or local healthcare providers office. They'll be more than willing to offer assistance. And Finally... If you have any questions about how Prescription Hope can help you save money on any of the 1,500 medications that we offer, then visit our website here. If you're having trouble affording any of the medications you've been prescribed, contact us, or visit the enrollment page to create an account and fill out an application to start saving.

1.8Narrow therapeutic index (NTI) medications

Narrow-Therapeutic Index Drugs Below, we've put together a non-exhaustive list of some of the most commonly encountered narrow-therapeutic index drugs in the pharmacy setting. For the PTCB exam, candidates are expected to have knowledge of: The definition of narrow-therapeutic index drugs Why these drugs require close monitoring Understanding the reasons why some drugs have a narrow index Examples of commonly encountered NTI medicines With these syllabus requirements in mind, let's review some of the most widely known NTI medicines - the top 20 NTI medicines and their indications. NTI MedicineIndicationsCarbamazepinePhenytoinValproic acidSeizures,Seizures, bipolar disorder, neuropathic painSeizures, bipolar disorderDigoxinAtrial fibrillationLithiumBipolar disorderWarfarinHeparinThrombosis / blood clotsTheophyllineAsthma / COPDMethotrexateRheumatoid arthritisA variety of cancersClozapineSchizophreniaCyclosporineImmunosuppressionOrgan transplant rejectionRheumatoid arthritis / psoriasisLevothyroxineHypothyroidismVancomycinSevere Gram-positive bacterial infectionsIsotretinoinSevere acneSome cancersAmphotericin BSevere fungal infectionsAmiodaroneClass III antiarrhythmic drugAminoglycosidesBacterial infectionsCaused by Gram-negative aerobesClomipramineAmitriptylineTricyclic antidepressantRifampicinTuberculosisLeprosyMycobacterium avium complexLegionnaire's disease

Nonsterile Compounding:

Nonsterile Compounding: Combining, admixing, diluting, pooling, reconstituting other than as provided in the manufacturer's labeling or otherwise altering a drug or bulk drug substance to create a nonsterile medication.

Drug-Food Interactions

One example of a drug-nutrient interaction involves foods high in vitamin K, such as spinach, broccoli, and kale. Eating foods high in vitamin K can keep warfarin (a blood thinner) from working properly.

Oral PreparationsTablets

Oral PreparationsTabletsTo form a Tablet the drug is combined with fillers and is then compressed into a hard pellet. There are various shapes, sizes and colors of tablets. Tablets are available in fast acting, slow release, controlled release, enteric coated, film coated, sublingual, chewable and other formulations. Not all oral Dosage Forms / tablets are swallowed.(SL) tablets are placed under the tongue, wafers are placed on the tongue and BUCCAL tablets are placed between the cheek and the gum.

Oral Solutions

Oral SolutionsThe drug is dissolved completely into a liquid form

Oral Solutions

Oral SolutionsThe drug is dissolved completely into a liquid form.

Oral powders

Oral powdersDrugs which are in a powder form and are usually dissolved in juice or water before administration

1.1Generic names, brand names, and classifications of medications

PTCB

Parenteral medications

Parenteral medications are injected or placed into the body tissues and do not pass through the liver before entering the bloodstream. This can include injections, topical and inhalation routes. Generally in pharmacy, parenteral refers to injection. Topical and inhalation routes are separated into their own routes of administration.

lInjectable Preparations

ParenteralInjectable PreparationsEpiduralInjected into the dura matter (epidural space) of the spinal cord.IntravenousInjected into the vein. This allows for immediate adsorption. Intravenous includes IV push, IV piggyback and IV infusion or drip.IntramuscularInjected into the muscle.SubcutaneousInjected into the fatty layer under the skin.IntradermalInjected into the top layer of the skin at a slight angle.IntracardiacInjected into the heart.IntraocularInjected within the eye.IntrathecalInjected into the space surrounding the spinal cord.Intra-articularInjected into the joint.

Syrups

SyrupsContain a high concentration of sucrose or sugar to sweeten, for ease

theraputic equivalence

Per the U.S. Food and Drug Administration (FDA), two medicines that have the same clinical effect and safety profile are said to have therapeutic equivalence. These two drugs, each from a different manufacturer, are known to have nearly identical properties and can be interchanged as needed. These medicines are sometimes referred to as brand name medications and generic medications. Per the FDA, there should be no clinical difference between them, although patients often notice a difference in cost. This is what you're most likely to notice while you're in the pharmacy trying to find something to stop your headache. The purpose of establishing if two medications are therapeutic equivalents is to allow the generic drug to go through a shorter, more cost-effective, approval process while still protecting public safety. For a drug to be approved as a therapeutic equivalent it must: Be safe and effective Contain the same active ingredient as the original medication Utilize the same route of administration Be the same dosage Meet the same standards for strength, quality, purity, and identity Be bioequivalent - the body is able to process it in the same way that the original drug was processed Be correctly labeled Be manufactured in accordance with the FDA's Current Good Manufacturing Practice regulations Testing can be preformed in vitro or in vivo. In vitro refers to when a test is done outside the living environment, sometimes referred to as 'test tube studies'. In vivo refers to when a test is done on the entire living organism, such a when a drug trial is conducted on human participants. Of note, these drugs do NOT need to have the same: Appearance: scoring, color, shape Flavor Packaging Preservatives Release mechanisms Minor aspects of labeling Sometimes, one of the above will be of particular importance to a patient, and a physician may prescribe a brand-specific product. The most important part of this is that the drugs have the same active ingredient. So, both Tylenol® and the store brand drug must contain acetaminophen, even though they will be produced by different companies. While acetaminophen and ibuprofen can both be used to treat your headache, because they are different medications they would never be considered therapeutic equivalents.

1.8Narrow therapeutic index (NTI) medications

Pharmacists should be aware that the Narrow Therapeutic Index Drug concept is found in the state's Product Selection Law, G.S. 90-85.27 and .28. Levothyroxine qualifies as an NTI drug under this statute which means that pharmacists need to get the documented consent of the prescriber and the patient before switching manufacturers on refills.

Pimozide(This medication is used to reduce uncontrolled movements (motor tics) or outbursts of words/sounds (vocal tics) caused by Tourette syndrome. Pimozide is a medication that works by decreasing the activity of a natural substance (dopamine) in the brain. Pimozide should not be used for mild symptoms.) and KetoconazolePimozide (Ketoconazole is used to treat certain serious fungal infections in the body. Ketoconazole belongs to the class of drugs called azole antifungals. It works by stopping the growth of the fungus. Ketoconazole should not be used to treat fungal infections in the brain or on the skin and nails).

Pimozide and KetoconazolePimozide alone can prolong the QT interval, and it has been linked with ventricular arrhythmias (torsades de pointes).(5)When pimozide is combined with ketoconazole, the combination can be deadly. Pimozide is a CYP3A4 enzyme substrate, and ketoconazole is a potent inhibitor of CYP3A4. This leads to marked increases in pimozide serum levels.(5)Other drugs?such as itraconazole, clarithromycin, erythromycin, diltiazem, and nefazodone?are also potent inhibitors of CYP3A4 and should not be administered with pimozide.(5)Fluconazole is weaker, but in larger doses it also inhibits CYP3A4. Terbin-afine is a safer choice because it does not affect CYP3A4.(5)

Potassium Chloride(This medication is a mineral supplement used to treat or prevent low amounts of potassium in the blood. A normal level of potassium in the blood is important. Potassium helps your cells, kidneys, heart, muscles, and nerves work properly.) and Spironolactone (Spironolactone is used to treat certain patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone); low potassium levels; heart failure; and in patients with edema (fluid retention) caused by various conditions, including liver, or kidney disease.)

Potassium Chloride and SpironolactoneThis is another significant drug interaction that has been known for a long time. The combination may result in hyperkalemia.(8)The resulting hyperkalemia can be serious and may lead to cardiac failure and death. Patients with renal impairment are especially prone to this effect. Spironolactone is a competitive antagonist of mineral corticoids, of which aldosterone is a potent example.(9)This mechanism occurs in the kidney at the distal portion of the nephron and leads to the excretion of sodium ions while saving potassium ions.(9)Patients receiving potassium-depleting diuretics, such as amiloride or triamterene, may also experience this interaction. These diuretics can interact with all absorbable forms of potassium?bicarbonate, citrate, acetate, gluconite, and iodide salts.(9)Severe hyperkalemia is dangerous, and thus patients who are prescribed spironolactone must undergo an evaluation of serum potassium levels.(9)

Rectal SuppositoriesSolid

Rectal SuppositoriesSolid or semi-solid bullet shaped dosage forms. They melt at body temperature, dispersing the medication.

Drug-Food Interactions

Table 1 Herbal and Dietary Supplement-Drug Interactions HERBAL OR DIETARY SUPPLEMENTDRUGCOMMENTRECOMMENDATION* Patients taking oral anticoagulants Cranberry (juice) Warfarin (Coumadin) Interaction possible based on seven reports of increased INR, although a clinical study showed no interactions4-7 Suspect an interaction if INR elevated Fish oil Warfarin Interaction possible, with case reports showing an elevated INR, although a clinical study showed no effect of fish oil on anticoagulation status8,9 Suspect an interaction if INR elevated Garlic Warfarin Interaction unlikely based on a clinical study that found garlic is relatively safe and poses no serious hemorrhagic risk for closely monitored patients taking warfarin oral anticoagulation therapy10 Suspect an interaction if bruising or bleeding occurs despite an appropriate INR One review found no case reports of interactions with garlic and warfarin11 Ginkgo Warfarin Interaction possible, though controlled clinical studies show no effect of ginkgo on the kinetics or dynamics of warfarin12,13 Experts recommend caution, although available research does not support this conclusion Aspirin Interaction suspected based on four case reports of spontaneous bleeding14,15 Suspect an interaction if spontaneous bleeding occurs Ginseng Warfarin Interaction possible based on conflicting research findings Avoid combination if possible American ginseng (Panax quinquefolius) reduces blood concentrations of warfarin16,17 Coadministration of warfarin with Asian ginseng (Panax ginseng) did not affect the pharmacokinetics or pharmacodynamics of warfarin18 St. John's wort Warfarin Interaction suspected based on decreases in INR in case reports and in a study in 12 healthy volunteers18 Evaluate warfarin response when St. John's wort is initiated or stopped Vitamin E (> 400 IU daily) Warfarin Interaction suspected based on a single patient (with rechallenge), resulting in an increase in INR19 Evaluate warfarin response when vitamin E is used in combination One clinical trial showed no interaction20 Patients taking cardiovascular medications Eleuthero (Eleutherococcus senticosus) [ corrected] Digoxin Possible increase in digoxin levels without clinical signs (case report)21 Monitor digoxin level when eleuthero is initiated or stopped [ corrected] St. John's wort Digoxin Suspected decrease in digoxin levels without clinical signs in a controlled study22 Monitor digoxin level when St. John's wort is initiated or stopped Verapamil (Calan) Interaction suspected based on decreased bioavailability in a study in eight healthy volunteers23 Increase verapamil dose, if necessary, if diminished response occurs Statins Interaction suspected based on decreased plasma blood levels in a clinical study24 Monitor serum lipid levels after St. John's wort is added Patients taking psychiatric medications Ginkgo Atypical antidepressant (trazodone [Desyrel]) Interaction possible based on one case report of coma25 Evaluate for emotional and/or behavioral changes in patient response after ginkgo is initiated or stopped Ginseng Monoamine oxidase inhibitors Interaction possible based on two case reports of manic-like symptoms, headache, and tremulousness17 Avoid combination if possible St. John's wort SSRIs Interaction suspected based on case reports of drowsiness or serotonin syndrome26 Taper off St. John's wort when initiating an SSRI Benzodiazepines Interaction suspected based on pharmacokinetic studies showing decreased serum levels (25 to 50 percent) without clinical signs27-29 Adjust the dose of benzodiazepine as needed Tricyclic antidepressants Interaction possible based on decreased amitriptyline plasma levels but no clinical effects in a study of 12 depressed patients27,30

Oral Routes of adminstration

Tablets,Liquid dosageforms,solutions,susepsions,emulstions,collioids,powders and effervesent salst to add to water, suspensions

dosage forms

SPL Acceptable TermCodeAEROSOLC42887AEROSOL, FOAMC42888AEROSOL, METEREDC42960AEROSOL, POWDERC42971AEROSOL, SPRAYC42889BAR, CHEWABLEC42892BEADC42890CAPSULEC25158CAPSULE, COATEDC42895CAPSULE, COATED PELLETSC42896CAPSULE, COATED, EXTENDED RELEASEC42917CAPSULE, DELAYED RELEASEC42902CAPSULE, DELAYED RELEASE PELLETSC42904CAPSULE, EXTENDED RELEASEC42916CAPSULE, FILM COATED, EXTENDED RELEASEC42928CAPSULE, GELATIN COATEDC42936CAPSULE, LIQUID FILLEDC42954CELLULAR SHEETC100103CHEWABLE GELC134876CLOTHC60884CONCENTRATEC60891CREAMC28944CREAM, AUGMENTEDC60897CRYSTALC42901DISCC43525DOUCHEC42679DRESSINGC42763ELIXIRC42912EMULSIONC42913ENEMAC42915EXTRACTC42929FIBER, EXTENDED RELEASEC60926FILMC42932FILM, EXTENDED RELEASEC42920FILM, SOLUBLEC42984FOR SOLUTIONC60927FOR SUSPENSIONC60928FOR SUSPENSION, EXTENDED RELEASEC60929GASC42933GELC42934GEL, DENTIFRICEC42906GEL, METEREDC60930GLOBULEC42937GRANULEC42938GRANULE, DELAYED RELEASEC42903GRANULE, EFFERVESCENTC42909GRANULE, FOR SOLUTIONC42939GRANULE, FOR SUSPENSIONC42940GRANULE, FOR SUSPENSION, EXTENDED RELEASEC42921GUM, CHEWINGC42894IMPLANTC42942INHALANTC42944INJECTABLE FOAMC113106INJECTABLE, LIPOSOMALC60931INJECTIONC42946INJECTION, EMULSIONC42914INJECTION, LIPID COMPLEXC42950INJECTION, POWDER, FOR SOLUTIONC42974INJECTION, POWDER, FOR SUSPENSIONC42976INJECTION, POWDER, FOR SUSPENSION, EXTENDED RELEASEC42977INJECTION, POWDER, LYOPHILIZED, FOR LIPOSOMAL SUSPENSIONC42959INJECTION, POWDER, LYOPHILIZED, FOR SOLUTIONC42957INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSIONC42958INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION, EXTENDED RELEASEC42956INJECTION, SOLUTIONC42945INJECTION, SOLUTION, CONCENTRATEC42899INJECTION, SUSPENSIONC42995INJECTION, SUSPENSION, EXTENDED RELEASEC42926INJECTION, SUSPENSION, LIPOSOMALC42951INJECTION, SUSPENSION, SONICATEDC42988INSERTC60933INSERT, EXTENDED RELEASEC42922INTRAUTERINE DEVICEC47915IRRIGANTC42947JELLYC42948KITC47916LINIMENTC42949LIPSTICKC42952LIQUIDC42953LIQUID, EXTENDED RELEASEC60934LOTIONC29167LOTION, AUGMENTEDC60957LOTION/SHAMPOOC60958LOZENGEC42955MOUTHWASHC29269NOT APPLICABLEC48624OILC42965OINTMENTC42966OINTMENT, AUGMENTEDC60984PASTEC42967PASTE, DENTIFRICEC42907PASTILLEC60985PATCHC42968PATCH, EXTENDED RELEASEC42923PATCH, EXTENDED RELEASE, ELECTRICALLY CONTROLLEDC42911PELLETC42969PELLET, IMPLANTABLEC42943PELLETS, COATED, EXTENDED RELEASEC42918PILLC25394PLASTERC42970POULTICEC47913POWDERC42972POWDER, DENTIFRICEC42908POWDER, FOR SOLUTIONC42973POWDER, FOR SUSPENSIONC42975POWDER, METEREDC42961RINGC60988RINSEC42979SALVEC42980SHAMPOOC42981SHAMPOO, SUSPENSIONC42982SOAPC42983SOLUTIONC42986SOLUTION, CONCENTRATEC42898SOLUTION, FOR SLUSHC42987SOLUTION, GEL FORMING / DROPSC60994SOLUTION, GEL FORMING, EXTENDED RELEASEC42935SOLUTION/ DROPSC60992SPONGEC47912SPRAYC42989SPRAY, METEREDC42962SPRAY, SUSPENSIONC42990STICKC42991STRIPC47914SUPPOSITORYC42993SUPPOSITORY, EXTENDED RELEASEC42924SUSPENSIONC42994SUSPENSION, EXTENDED RELEASEC42925SUSPENSION/ DROPSC60995SWABC47898SYRUPC42996SYSTEMC17423TABLETC42998TABLET, CHEWABLEC42893TABLET, CHEWABLE, EXTENDED RELEASEC124794TABLET, COATEDC42897TABLET, COATED PARTICLESC60997TABLET, DELAYED RELEASEC42905TABLET, DELAYED RELEASE PARTICLESC42997TABLET, EFFERVESCENTC42910TABLET, EXTENDED RELEASEC42927TABLET, FILM COATEDC42931TABLET, FILM COATED, EXTENDED RELEASEC42930TABLET, FOR SOLUTIONC61004TABLET, FOR SUSPENSIONC61005TABLET, MULTILAYERC42964TABLET, MULTILAYER, EXTENDED RELEASEC42963TABLET, ORALLY DISINTEGRATINGC42999TABLET, ORALLY DISINTEGRATING, DELAYED RELEASEC61006TABLET, SOLUBLEC42985TABLET, SUGAR COATEDC42992TABLET WITH SENSORC147579TAMPONC47892TAPEC47897TINCTUREC43000TROCHEC43001WAFER

1.10Proper storage of medications (e.g., temperature ranges, light sensitivity, restricted access

Safe Storage of Medications In health care facilities, medications must be stored and monitored to prevent theft or diversion. Indian Health Service policies, as well as state, Tribal, and federal regulations govern the security, inventory, and climate control of medications. Requirements for storage can often be found also on the medication's label. Patients should be educated on how to safely store their medications at home to prevent theft or accidental poisoning. Security Medications, especially controlled substances, must be securely stored in accordance with laws, regulations, and organizational policies. Depending on state and federal laws governing a particular area, controlled substances may need to be stored in separate rooms from other medications or with different locks. Access to these medications and areas should be restricted to authorized persons only. Procurement, transfer, and disposal of controlled substances are regulated by the Drug Enforcement Administration and Indian Health Service policy, as well as state, Tribal, and federal law. Inventory All medications must be accurately labeled with the contents, expiration date, and appropriate warnings. Appropriate labeling also reduces the risk of medical errors, such as incorrect medication selection or use of an expired and less-potent medication. Separate inventories of controlled substances must be regularly maintained: one inventory for Schedule II drugs and one for Schedules III through V drugs. All purchases, transfers, and disposals must be maintained in the inventory records. They must be conducted in compliance with Drug Enforcement Administration and Indian Health Service policy. They also have to be in compliance with state, Tribal, and federal law. Climate All medications have various storage requirements, such as temperature, low humidity, protection from light, and other considerations. Storage requirements help ensure that medications maintain their potency and help reduce the risk of harm to patients. Medication storage requirements may be found on the medication's label or from a third-party resource

Solutions

SolutionsThe drug is dissolved completely into a liquid form.Oral SuspensionsThe drug is mixed with, but not completely dissolved into a liquid. It needs to be shaken before administration in order to suspend the drug particles evenly.

Statins and GrapefruitStatins

Statins and GrapefruitStatins are highly effective cholesterol-lowering drugs. Unfortunately, says Zive, "Drinking grapefruit juice or eating fresh grapefruit can increase the amount of some statins in your blood and lead to potentially greater side effects of these drugs." Side effects of statins include muscle soreness and liver abnormalities reflected in high transaminase levels (serum glutamic-oxaloacetic transaminase and serum glutamic pyruvic transaminase) on a blood test. This interaction is especially strong with simvastatin (Zocor) and lovastatin (Altoprev), milder with atorvastatin (Lipitor), and nonexistent for pravastatin (Pravachol), so it's important for elders to check whether their prescribed statin drugs do interact before giving up vitamin C-rich grapefruit.

1.9Physical and chemical incompatibilities related to non-sterile compounding and reconstitution

Sterile compounded medications are intended to be used as injections, infusions, or application to the eye. Non-sterile medications include the production of solutions, suspensions, ointments, creams, powders, suppositories, capsules, and tablets

drug disease

The 2 most common drug-disease interactions were use of first-generation calcium channel blockers in patients with congestive heart failure and use of aspirin in patients with peptic ulcer disease (both, 3.7%).

Clonidine(Clonidine treats high blood pressure by decreasing your heart rate and relaxing the blood vessels so that blood can flow more easily through the body. Clonidine extended-release tablets may treat ADHD by affecting the part of the brain that controls attention and impulsivity) and Propranolol ( Beta blocker It can treat high blood pressure, chest pain (angina), and uneven heartbeat (atrial fibrillation). It can also treat tremors and proliferating infantile hemangioma. In addition, it can prevent migraine headaches.)

The combination may produce a mysterious hypertension that is unrelated to the pharmacology of either agent when administered independently.(8)A sudden withdrawal of clonidine from adjunctive therapy with propranolol may cause fatal rebound hypertension.Clonidine is a central alpha-2 adrenergic agonist that suppresses the sympathetic nervous system from the brain.(10)This activity leads to a decrease in the norepinephrine amounts available in the synaptic cleft of the adrenergic neuron. Alpha-1 receptors then become sensitized because of less norepinephrine available in the cleft.(10)When clonidine is suddenly withdrawn, the result is a large increase in norepinephrine in the synaptic cleft of the adrenergic neuron. The sensitized alpha-1 receptors are stimulated, leading to an exaggerated vasoconstriction. The body cannot compensate for this response because the beta-2 receptors are blocked when a patient is concurrently taking propranolol. Within 24 to 72 hours, a dramatic rebound hypertension is noticed.(9)

dosage form

The physical manifestation of the drug or how the drug is supplied. Dosage forms, also known as Routes of administration describe the physical form in which medication will be delivered into the body.

Theophylline(Bronchodilator It can treat asthma and other lung problems, such as emphysema and chronic bronchitis.) and CiprofloxacinConcurrent (This medication is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections)

Theophylline and CiprofloxacinConcurrent administration may lead to toxic increases in theophylline.(11)This problem occurs because the hepatic metabolism of theophylline is inhibited by ciprofloxacin via the cytochrome P-450 enzyme system. Theophylline is metabolized by CYP1A2 and to a lesser extent by CYP3A4. Ciprofloxacin and other drugs, including clarithromycin, erythromycin, fluvoxamine, and cimetidine, are all potent inhibitors of CYP1A2. Because they have little effect on CYP1A2, levofloxacin or ofloxacin should be considered as an alternative to ciprofloxacin.(5)Theophylline toxicity is a serious condition; several deaths have been linked with serum concentrations as low as 25 mcg/mL.(11)Signs of theophylline toxicity include headache, dizziness, hypotension, hallucinations, tachycardia, and seizures.(11)

Tinctures

TincturesMay contain as little as 17% alcohol or as much as 80% alcohol.

Topical dosages

Topical dosages are applied to the skin surface or a mucous membrane.

Transdermal patchA

Transdermal patchA medicated adhesive patch applied directly on the skin to deliver a specific dosage of a drug. They have systemic effects and should be rotated to different sites on the body.

drug-lab interactions

True drug-lab test interactions are the result of a drug altering the test specimen, or direct interference from the drug itself reacting with the test reagents. Despite their importance, surprisingly little is known about drug interactions with lab tests.

Drug-Disease Interactions

Various diseases may inhibit the absorption, metabolism, and elimination of different drugs.Common Types of Drug-Disease Interactions Every time a patient takes a drug, the drug has to travel through their unique body. The process by which a drug is metabolized can vary from patient to patient and it can depend on the bacteria that dwell in the intestines, on the patient's age, or on the general health of their excretory organs, such as the liver or kidneys. As the drug passes through the body, chemical reactions occur that make it water-soluble so that it can eventually be excreted and will not accumulate to toxic levels within the bloodstream. However, because of various disease conditions, sometimes this process doesn't go quite as planned. Let's look at some of these disease conditions and how they affect the patient's ability to metabolize various medications. Chronic Kidney Disease In chronic kidney disease, or CKD, the kidneys have been damaged and their function has been compromised. This means that any drug that is toxic to the kidneys, or is nephrotoxic, must be prescribed with care, especially in more advanced stages of CKD. Also, any drug that is converted to a metabolite, or water-soluble form, and is then excreted through the kidneys may have delayed excretion in a patient with CKD and may accumulate in the body to toxic levels. The kidneys also play a role in endocrine function, and when they are diseased, some of this function is lost. This may affect how a drug is metabolized. For these reasons, a clinician needs to consider if there is a less toxic drug to prescribe for the patient with CKD, or if an adjusted dose would be appropriate. Cardiovascular Disease There are many pre-existing cardiac conditions that don't work well with certain drugs. One of these is hypertension, or high blood pressure. Many over-the-counter decongestants, like pseudoephedrine, are great for clearing up the congestion of a bad cold, but since they shrink the blood vessels, they raise the blood pressure. This can be dangerous for a patient whose blood pressure is difficult to control. Non-steroidal anti-inflammatory drugs, or NSAIDS, may also be dangerous in the context of high blood pressure because they cause fluid retention. Antacids also cause fluid retention and often contain magnesium, which can affect the heart rhythm. Digestive Disease Of all the drugs that are hard on the digestive system, NSAIDs are probably the worst, as they wear away the stomach lining and increase stomach acidity. Patients with peptic ulcer disease should not take NSAIDS. In inflammatory bowel diseases, such as Crohn's disease, the walls of the intestines are often thickened, which slows the absorption of any drug. Many drugs are metabolized in the liver, so liver diseases, like cirrhosis, cause the drugs to accumulate in the blood, which, again, may lead to toxicity. Other Types Of Disease There are also other conditions that make taking certain drugs riskier, such as asthma and gout. Beta blockers are drugs commonly given for heart failure and hypertension, but these must be given with caution to those with asthma because their blocking action on beta receptors, which is therapeutic for hypertension, also causes constriction of the airways. In a patient who has gout, taking diuretics can cause the retention of uric acid. Gout is caused by the buildup of uric acid in the joints, so the retention of more uric acid simply worsens the disease. Number of potential drug-disease interactions 1346 (55.4) ≥ 254 (8.7)NSAIDs* in patients with hypertension and/or chronic heart failure384 (61.5)β blocking agents in patients with diabetes mellitus31 (5.0)NSAIDs* in patients with chronic renal insufficiency18 (2.9)NSAIDs* in patients with previous peptic ulcer

Warfarin (Blood thinners It can treat and prevent blood clot) and Diflunisal (Nonsteroidal anti-inflammatory drug It can treat pain and arthritis)

Warfarin and Diflunisal Nonsteroidal anti-inflammatory drugs (NSAIDs), such as diflunisal, have been shown to increase the risk for gastrointestinal (GI) bleeding and the anticoagulant response of war-farin.(5)Other NSAIDs?such as keto-profen, piroxicam, sulindac, diclo-fenac, and ketorolac?have been shown to have similar interactions with warfarin. In most patients, however, indomethacin has little effect on hypothrombinemic response.(5)Because the interaction between warfarin and diflunisal can lead to GI bleeding or even fatal hemorrhaging, an alternative to diflunisal is suggested. Acetaminophen is the alternative of choice. Yet, if an NSAID is needed, nonacetylated salicylates?such as magnesium salicylate or salsalate?are safer because of minimal effects on platelets and gastric mucosa.(5)

Warfarin and Vitamin KWarfarin (Coumadin)

Warfarin and Vitamin KWarfarin (Coumadin) is a blood-thinning medication that helps treat and prevent blood clots. Eating certain foods, especially those rich in vitamin K, can diminish warfarin's effectiveness. The highest concentrations of vitamin K are found in green leafy vegetables such as kale, collards, spinach, turnip greens, Brussels sprouts, broccoli, scallions, asparagus, and endive

1.8Narrow therapeutic index (NTI) medications

We defined the following drugs to be NTI-drugs: aminoglycosides, ciclosporin, carbamazepine, digoxin, digitoxin, flecainide, lithium, phenytoin, phenobarbital, rifampicin, theophylline and warfarin

1.10Proper storage of medications (e.g., temperature ranges, light sensitivity, restricted access

What is the effect of light on medication storage? Light is another aspect of the environment that effects medications. If a medication is stored in an amber bottle, it should remain stored in the bottle to prevent degradation. UV light can change the chemical structure of sensitive medications such as potassium iodide and tinctures

1.9Physical and chemical incompatibilities related to non-sterile compounding and reconstitution

What practices are not subject to USP <795>? Administration: Preparation of a single dose for a single patient when administration begins with 4 hours of the beginning of the preparation. Nonsterile Radiopharmaceuticals: This is subject to USP <825> (Radiopharmaceuticals - Preparation, Compounding, Dispensing and Repackaging) Reconstitution of a conventionally manufactured nonsterile product: Only if in accordance with the directions contained in the manufacturer approved labeling. Splitting Tablets: Breaking or cutting a tablet into smaller portions. Repackaging: repackaging of conventionally manufactured drug products.

Drug-Food Interactions

You may not realize that certain foods or drinks can affect how your medication works. Some foods or drinks may need to be avoided altogether for your medication to work correctly. You may know to ask your pharmacist if your medication should be taken with or without food, but did you know that certain foods may need to be avoided altogether? Food can interact with certain drugs by either causing too much or too little of the drug to exert its effect in the body. This can lead to unwanted side effects, toxic levels of a drug in the body, or little to no effect of the drug. Learn about the most common food and drug interactions below. Alcohol Alcohol can be a problem when taken with your medications for a number of reasons. First, alcohol itself is considered a drug and as such, has side effects. It can impair your judgment, cause drowsiness or sedation, and affect your coordination. For medications that have similar side effects, this can be a problem. Alcohol is also metabolized by the liver. If you drink three or more alcoholic drinks a day, taking medications that are also metabolized by the liver can put you at an increased risk of liver damage. Some medications that alcohol can interfere with include: Antihistamines: Antihistamines are used to treat allergies and can cause an increase in drowsiness. Claritin (loratadine), Zyrtec (cetirizine), Benadryl (diphenhydramine), and Allegra (fexofenadine) are all in the class of antihistamines. Pain relievers: Tylenol (acetaminophen) is metabolized by the liver like alcohol. Ask your doctor about taking this medication if you drink three or more alcoholic beverages a day. Non-steroidal anti-inflammatory drugs (NSAIDS) like Motrin (ibuprofen), Aleve (naproxen), or aspirin can cause stomach bleeds. Again, drinking more than three alcoholic drinks a day can increase this bleeding risk. Narcotic pain relievers: These pain relievers cause a significant amount of drowsiness on their own. Taking them with alcohol can cause increased drowsiness, respiratory depression (breathing problems), or even death. You should avoid alcohol when taking any narcotic pain relievers such as codeine, hydrocodone, or morphine, for example. Metronidazole: Metronidazole is used for certain types of infections and alcohol should not be consumed at all when you are on this medication. Taking alcohol with this medication can lead to nausea, severe vomiting, flushing, headache, and stomach cramps. Wait at least one full day after finishing this medication before drinking any alcohol. Psychiatry medications: Drugs used to treat depression, anxiety, bipolar disease, and other psychiatric conditions will most likely have an interaction with alcohol. Check with the pharmacist at your community pharmacy before combining these drugs with alcohol, which could lead to significant drowsiness or sedation. Grapefruit juice You may be aware that grapefruit juice should be avoided while taking many different types of medications. Grapefruit juice can either interfere with the metabolism of the drug and cause too high of a level of the drug in the body, or it can block the drug from even being absorbed from the gastrointestinal tract, making the drug ineffective. Some common drugs that grapefruit juice may interfere with include: Statin drugs for cholesterol like Zocor (simvastatin), Crestor (rosuvastatin), or Lipitor (atrovastatin) Blood pressure medicine Procardia (nifedipine) Organ transplant anti-rejection drug Neoral or Sandimmune (cyclosporin) Antiarrhythmic drug Pacerone or Cordarone (amiodarone) Antibiotic Erythromycin Antidepressant Zoloft (sertraline) Potassium Foods high in potassium, such as bananas, watermelon, potatoes, avocados, coconut water, green leafy vegetables, salt substitutes, and beans can interact with medications that can retain potassium in the body. One class of drugs used to treat high blood pressure, ACE inhibitors, can interact with foods high in potassium, potentially raising your potassium levels too high. Some examples of ACE inhibitors include captopril, enalapril, and lisinopril. Potassium-sparing diuretics (water pills) such as triamterene and spironolactone may have this same reaction with potassium-rich foods. Vitamin K Vitamin K plays an important part in your body's ability to clot. If you are taking a blood thinner like Coumadin (warfarin), keeping a consistent diet of foods known to be high in vitamin K is important. Suddenly increasing your intake of foods rich in vitamin K could lead to the drug coumadin, or its generic medicine warfarin, not working as effectively. Foods known to be high in vitamin K include broccoli, cabbage, spinach, collard greens, turnip greens, kale, and Brussel sprouts. Tyramine Tyramine is found naturally in aged or fermented foods such as aged cheeses, dried sausage or salami, pickled, fermented, or smoked foods, excessive amounts of chocolate, yeast extract, and sauerkraut. If you are taking an antidepressant found in the monoamine oxidase inhibitors (MAOI) class such as phenelzine or tranylcypromine, you should not consume any foods containing tyramine. Other medications that can interact with tyramine-rich foods include Zyvox (linezolid) and isoniazid. Calcium Calcium-rich foods such as milk, yogurt, cheese, calcium supplements, and calcium antacids can interact with certain antibiotics. Some antibiotics that calcium may interfere with include tetracycline, doxycycline, and Cipro (ciprofloxacin). Taking foods or supplements either 1 hour before or 2 hours after taking the antibiotic will allow the drug to still be absorbed. Taking Medications With or Without Food Sometimes the question is not what foods you should avoid, but does the medication need to be taken on an empty or full stomach. Below are some examples of medications that should either be taken with or without food. NSAIDS like Motrin (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib) should be taken with food ACE inhibitors captopril and moexipril should be taken one hour before meals Beta-blocker carvedilol should be taken with food Heart medication Lanoxin (digoxin) should be taken either one hour before or two hours after eating food Proton pump inhibitors like omeprazole, lansoprazole, and pantoprazole, in general, should be taken one hour before eating Thyroid medication like Synthroid (levothyroxine) should be taken in the morning on an empty stomach It is important to realize that there are many foods that may interact with your medications. Whether the medication is a compound medication or manufactured medication, contact Smith-Caldwell drug store, your community pharmacy, to check on these and other food-drug interactions.

brand-name drug

a drug with a registered name or trademark given to a drug by a pharmaceutical company

Tablets

iThe most common solid dosage forms available is a soilid form by compression of dry drug ingrediants pg 158 dekated reekese formulations, compression tablets, like acctaminophon, a mutiple compression tablet like Ambien core of two outer shells, chewable tablet, oral disteinteragting tablet melts in your mouth for pediatic and geatric patients, caplets easy to swallow not (see chapter 5 for specific s)

generic name

name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name

SEE CHAPTER 5 IN PHARMACY PRACTICE FOR TECH CHAPTER 5

rOUTES of adminstration and dosage forms

1.5Common and severe medication side effects, adverse effects, and allergies

side effects A side effect is usually regarded as an undesirable secondary effect which occurs in addition to the desired therapeutic effect of a drug or medication. Side effects may vary for each individual depending on the person's disease state, age, weight, gender, ethnicity and general health.

drug-drug interactions

when the effect of a medication is changed, enhanced, or diminished when taken with another drug, including herbal substancesDrug-Drug Interaction Speaker. A change in a drug's effect on the body when the drug is taken together with a second drug. A drug-drug interaction can delay, decrease, or enhance absorption of either drug. This can decrease or increase the action of either or both drugs or cause adverse effects.