341 Med Proficiency Exam

Cetirizine (systemic)

Class: Histamine H1 Antagonist; Histamine H1 Antagonist, Second Generation; Piperazine Derivative MOA: Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract Use: PO: allergic rhinitis, urticaria chronic spontaneous; IV: urticaria new onset; off-label: anaphylaxis, Angioedema, acute allergic or recurrent idiopathic; Infusion reaction, premedication Administration: PO: w/out regard to food; IV: never IM or SUBQ, IV push over 1-2 min A/E: CNS effects; >10%: Nervous system: Drowsiness, HA Monitoring: Relief of symptoms, sedation, mental alertness, and anticholinergic effects.

Acetaminophen/Codeine

Class: Analgesic Combination (Opioid); Analgesic, Opioid MOA: -Acetaminophen: Although not fully elucidated, the analgesic effects are believed to be due to activation of descending serotonergic inhibitory pathways in the CNS -Codeine: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough suppression by direct central action in the medulla; produces generalized CNS depression. Use: pain management (mild to moderate), if alternate treatment options do not work Administration: oral solution or suspension; shake well before use A/E: Monitoring: Pain relief, respiratory and mental status, BP, HR; bowel function; S/S of substance use disorder, abuse, or misuse; S/S of hypogonadism or hypoadrenalism

Hydrocodone and acetaminophen

Class: Analgesic Combination (Opioid); Analgesic, Opioid MOA: -Hydrocodone: Binds to opiate receptors in the CNS, altering the perception of and response to pain; suppresses cough in medullary center; produces generalized CNS depression. -Acetaminophen: Although not fully elucidated, the analgesic effects are believed to be due to activation of descending serotonergic inhibitory pathways in the CNS. Use: pain management (severe pain if alternate ways do not work) Administration: A/E: Monitoring: Pain relief, respiratory and mental status, blood pressure; bowel function; signs/symptoms of misuse, abuse, and substance use disorder; signs or symptoms of hypogonadism or hypoadrenalism (Brennan 2013)

Acetaminophen/Oxycodone

Class: Analgesic Combination (Opioid); Analgesic, Opioid MOA: -Oxycodone: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression. -Acetaminophen: Although not fully elucidated, the analgesic effects are believed to be due to activation of descending serotonergic inhibitory pathways in the CNS. Use: pain management (if alternative treatments are not working and severe pain) Administration: oral solution A/E: CNS- dizziness; GI- nausea Monitoring: Pain relief, respiratory and mental status, BP; bowel function; S/S of misuse, abuse, and substance use disorder; S/S of hypogonadism or hypoadrenalism

Hydromorphone

Class: Analgesic, Opioid MOA: Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough suppression by direct central action in the medulla; produces generalized CNS depression Use: pain management; off-label: Critically ill patients in the ICU, analgesia and sedation Administration: parenteral, PO A/E: opioid-induced constipation/neurotoxicity/pruritus/respiratory depression/withdrawal Monitoring: Pain relief, respiratory and mental status, blood pressure; bowel function; signs/symptoms of misuse, abuse, and substance use disorder; signs or symptoms of hypogonadism or hypoadrenalism

Lisinopril

Class: Angiotensin-Converting Enzyme (ACE) Inhibitor; Antihypertensive MOA: Competitive inhibitor of angiotensin-converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion; a CNS mechanism may also be involved in hypotensive effect as angiotensin II increases adrenergic outflow from CNS; Use: HF w/ reduced EF; HTN chronic, ST-elevation MI; off-label: Migraine, prevention; Non-ST-elevation acute coronary syndrome; Posttransplant erythrocytosis, kidney transplant recipients; Proteinuric chronic kidney disease, diabetic or nondiabetic; Stable coronary artery disease Administration: PO- Administer as a single daily dose and without regard to meals. A/E: AKI, angioedema, cough, hyperkalemia; >10%: cardiac- hypotension; nervous system: dizziness Monitoring: Blood pressure; BUN; serum creatinine; electrolytes (eg, potassium [especially in patients on concomitant potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts]); consider baseline LFTs (if preexisting hepatic impairment); monitor for jaundice or signs of hepatic failure; if patient has collagen vascular disease and/or kidney impairment, periodically monitor CBC with differential. If angioedema is suspected, assess risk of airway obstruction

Atenolol

Class: Antianginal Agent; Antihypertensive; Beta-Blocker, Beta-1 Selective MOA: Competitively blocks response to beta-adrenergic stimulation, selectively blocks beta1-receptors with little or no effect on beta2-receptors except at high doses Use: angina, HTN, Myocardial infarction, early treatment and secondary prevention; off-label: Atrial fibrillation/flutter, maintenance of ventricular rate control; Marfan syndrome with aortic aneurysm; Migraine, prevention; Supraventricular tachycardia (atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia, multifactorial atrial tachycardia), maintenance of ventricular rate control; Thyrotoxicosis; Ventricular arrhythmias or ventricular premature beats (symptomatic), prevention Administration: PO (may be given without regard to food) A/E: bronchospasm, bradyarrhythmias, CNS effects, potential/masking of hypoglycemia, withdrawal; >10%: Cardiovascular: Bradycardia, HF, hypotension, supraventricular tachycardia, ventricular tachycardia Monitoring: BP; heart rate; mental alertness; signs and symptoms of bronchospasm in patients with existing bronchospastic disease; serum glucose (in patients with diabetes); kidney function.

Metoprolol Succinate

Class: Antianginal Agent; Antihypertensive; Beta-Blocker, Beta-1 Selective MOA: Selective inhibitor of beta1-adrenergic receptors; competitively blocks beta1-receptors, with little or no effect on beta2-receptors at oral doses <100 mg (in adults); does not exhibit any membrane stabilizing or intrinsic sympathomimetic activity Use: angina, HF w/ reduced EF, HTN chronic, MI; off-label: Atrial fibrillation/flutter; Atrial fibrillation prevention after cardiac surgery; Hypertrophic cardiomyopathy; Migraine, prevention; Supraventricular tachycardia; Thyrotoxicosis; Ventricular arrhythmias Administration: PO- w/ or w/out meals; IV A/E: bradyarrhythmias, bronchospasm, CNS effects, potentiation/masking of hypoglycemia, withdrawal; >10%: Cardiovascular: Bradycardia, hypotension Monitoring: ECG; heart rate; blood pressure; serum glucose (in patients with diabetes); mental alertness.

Metoprolol Tartrate

Class: Antianginal Agent; Antihypertensive; Beta-Blocker, Beta-1 Selective MOA: Selective inhibitor of beta1-adrenergic receptors; competitively blocks beta1-receptors, with little or no effect on beta2-receptors at oral doses <100 mg (in adults); does not exhibit any membrane stabilizing or intrinsic sympathomimetic activity Use: angina, HF w/ reduced EF, HTN chronic, MI; off-label: Atrial fibrillation/flutter; Atrial fibrillation prevention after cardiac surgery; Hypertrophic cardiomyopathy; Migraine, prevention; Supraventricular tachycardia; Thyrotoxicosis; Ventricular arrhythmias Administration: PO- w/ or w/out meals; IV A/E: bradyarrhythmias, bronchospasm, CNS effects, potentiation/masking of hypoglycemia, withdrawal; >10%: Cardiovascular: Bradycardia, hypotension Monitoring: ECG; heart rate; blood pressure; serum glucose (in patients with diabetes); mental alertness.

Amlodipine

Class: Antianginal Agent; Antihypertensive; Calcium Channel Blocker; Calcium Channel Blocker, Dihydropyridine MOA: Inhibits calcium ion from entering the "slow channels" or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina Use: angina, HTN; off-lablel: Raynaud phenomenon Administration: PO without regard to food A/E: peripheral edema Monitoring: Heart rate, BP; peripheral edema.

Cephalexin

Class: Antibiotic, Cephalosporin (First Generation) MOA: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Use: bone infections, otitis media, respiratory tract infections, skin and soft tissue infections, urinary tract infections; off-label: Endocarditis, prophylaxis; Prosthetic joint infection Administration: PO, with or without food A/E: c diff infection, hemolytic anemia, hypersensitivity reactions Monitoring: With prolonged therapy monitor renal, hepatic, and hematologic function periodically; monitor for signs of anaphylaxis during first dose

Levofloxacin (systemic)

Class: Antibiotic, Fluoroquinolone; Antibiotic, Respiratory Fluoroquinolone MOA: As the S(-) enantiomer of the fluoroquinolone, ofloxacin, levofloxacin, inhibits DNA-gyrase in susceptible organisms thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands. DNA gyrase, is an essential bacterial enzyme that maintains the superhelical structure of DNA and is required for DNA replication and transcription, DNA repair, recombination, and transposition. Use: Treatment of community-acquired pneumonia, including multidrug-resistant strains of Streptococcus pneumoniae; nosocomial pneumonia; chronic obstructive pulmonary disease, acute exacerbation; rhinosinusitis, acute bacterial; prostatitis; urinary tract infection; acute pyelonephritis; skin and soft tissue infections; inhalational anthrax (postexposure) to reduce incidence or disease progression; prophylaxis and treatment of plague due to Yersinia pestis; off-label: Anthrax; Bite wound infection, prophylaxis or treatment; Cervicitis or urethritis due to Chlamydia trachomatis infection; Diabetic foot infection; Administration: PO w/out regard to food; IV- don't infuse too fast can lead to hypotension A/E: aortic aneurysm/aortic dissection, arthropaty/arthralgia, CNS effects/neuroexcitation, c. diff, glucose regulation/dysglycemia, hepatotxicity, hypersensitivity reactions, myasthenia gravis, peripheral neuropathy, phototoxicity/photoallergy, QT prolongation, tendinopathy/tendon rupture Monitoring: Evaluation of organ system functions is recommended periodically during therapy; the possibility of crystalluria should be assessed; WBC and signs of infection, altered mental status, signs and symptoms of tendinopathy or peripheral neuropathy; signs and symptoms of disordered glucose regulation; rash; signs and symptoms of hypersensitivity reaction.

Azithromycin(systemic)

Class: Antibiotic, Macrolide MOA: Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation Use: Chancroid, Chronic obstructive pulmonary disease, acute exacerbation, Mycobacterium avium complex, Otitis media, acute, Pelvic inflammatory disease, Pneumonia, community-acquired, Rhinosinusitis, acute bacterial, Skin and skin structure infection, uncomplicated, Streptococcal pharyngitis, group A, Urethritis/cervicitis; off-label: Acne vulgaris, inflammatory, moderate to severe; Babesiosis; Bartonella spp. infection; Bronchiectasis... Administration: IV- infuse over 1-3 hr (not for IM or IV bolus); PO- w/out regard to food A/E: altered cardiac conduction, c. diff infection, drug induced liver injury, hypersensitivity reactions, ototoxicity; >10%- GI: diarrhea/nausea Monitoring: LFTs, symptoms of hepatitis (malaise, nausea, vomiting, abdominal colic, fever), CBC with differential, audiogram with prolonged use, ECG for QTc prolongation

Trimethoprim-sulfamethoxazole

Class: Antibiotic, Miscellaneous; Antibiotic, Sulfonamide Derivative MOA: Sulfamethoxazole interferes with bacterial folic acid synthesis and growth via inhibition of dihydrofolic acid formation from para-aminobenzoic acid; trimethoprim inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in sequential inhibition of enzymes of the folic acid pathway Use: Oral: Treatment of urinary tract infection (UTI) due to Escherichia coli, Klebsiella and Enterobacter spp, Morganella morganii, Proteus mirabilis, and Proteus vulgaris; acute otitis media; acute exacerbations of chronic obstructive pulmonary disease due to susceptible strains of Haemophilus influenzae or Streptococcus pneumoniae; treatment and prophylaxis of Pneumocystis pneumonia (PCP); infectious diarrhea due to enterotoxigenic E. coli; treatment of shigellosis caused by Shigella flexneri or Shigella sonnei. IV: Treatment of PCP; treatment of shigellosis caused by S. flexneri or S. sonnei; treatment of severe or complicated UTIs due to E. coli, Klebsiella and Enterobacter spp, M. morganii, P. mirabilis, and P. vulgaris. Administration: IV, PO- Administer without regard to meals. Administer with at least 8 ounces of water. A/E: C. diff, Drug-induced liver injury, Hematologic effects, Hyperkalemia, Hypoglycemia, Hyponatremia, Hypersensitivity reactions, Kernicterus Monitoring: CBC, electrolytes, renal function.

Amoxicillin/Clavulanate

Class: Antibiotic, Penicillin MOA: Clavulanic acid binds and inhibits beta-lactamases that inactivate amoxicillin resulting in amoxicillin having an expanded spectrum of activity. Amoxicillin inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Use: lower respiratory tract infection, otitis media (acute), Rhinosinusitis, acute bacterial, Skin and soft tissue infection, UTI; off-label: Bite wound infection, prophylaxis or treatment (animal or human bite); Diabetic foot infection; Intra-abdominal infection, mild to moderate, community acquired in patients without risk factors for resistance or treatment failure; Neutropenic fever, low-risk patients with cancer (empiric therapy); Odontogenic infection; Peritonsillar cellulitis or abscess; Streptococcus (group A), chronic carriage Administration: PO, give with food to help with absorption/decrease stomach upset (ER tablets give with food), IV over 3-4 min push or infusion over 30-40 min A/E: ABX associated (non-c. dif) diarrhea, c. dif diarrhea, drug induced liver injury, hypersensitivity Monitoring: Assess patient at beginning and throughout therapy for infection; with prolonged therapy, monitor renal, hepatic, and hematologic function periodically; in patients with hepatic impairment, monitor liver function tests at regular intervals; monitor for signs of anaphylaxis during first dose

Amoxicillin

Class: Antibiotic, Penicillin MOA: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Use: Ear, nose, and throat infections (pharyngitis/tonsillitis, acute otitis media), Helicobacter pylori eradication, Lower respiratory tract infections (including pneumonia), Rhinosinusitis, acute bacterial, Skin and soft tissue infection, UTI; off-label: Actinomycosis; Anthrax; Cervical infection in pregnancy due to Chlamydia trachomatis; Endocarditis, prophylaxis; Lyme disease (Borrelia spp. infection); Periodontitis, severe, plaque-associated; Pneumococcal prophylaxis in patients at high risk; Prosthetic joint infection, chronic suppression Administration: PO A/E: ABX associated (non-c. dif) diarrhea, c. dif diarrhea, hypersensitivity and immunologic reactions Monitoring: With prolonged therapy, monitor renal, hepatic, and hematologic function periodically; assess patient at beginning and throughout therapy for infection; monitor for signs of anaphylaxis during first dose

Heparin

Class: Anticoagulant MOA: Potentiates the action of antithrombin III and thereby inactivates thrombin and prevents the conversion of fibrinogen to fibrin; heparin also stimulates release of lipoprotein lipase Use: anticoagulation; off-label: Antibiotic lock technique, adjunctive therapy (catheter-salvage strategy); Frostbite; Mechanical heart valve, bridging anticoagulation (for interruptions in warfarin therapy); Mechanical heart valve, postsurgical management (to transition to warfarin); Non-ST-elevation acute coronary syndromes; Percutaneous coronary intervention; Peripheral arterial occlusion, acute; ST-elevation myocardial infarction Administration: IM, SUBQ, continuous IV infusion, intra-arterial, intravesicle A/E: major bleeding, osteoporosis, thromboycytopenia Monitoring: Hemoglobin, hematocrit, platelet count, PT, aPTT, signs/symptoms of bleeding, risk factors for bleeding, fecal occult blood test (if clinically indicated); potassium.

Warfarin

Class: Anticoagulant; Anticoagulant, Vitamin K Antagonist MOA: Hepatic synthesis of coagulation factors II (half-life 42 to 72 hours), VII (half-life 4 to 6 hours), IX, and X (half-life 27 to 48 hours), as well as proteins C and S, requires the presence of vitamin K. These clotting factors are biologically activated by the addition of carboxyl groups to key glutamic acid residues within the proteins' structure. Use: MI, thromboembolic complications Administration: PO- Administer with or without food. Warfarin should be administered orally once a day at approximately the same time. A/E: Atheroemboli/cholesterol microemboli, Calciphylaxis, Decreased bone mineral density, Hemorrhage, Skin necrosis/gangrene Monitoring: Prothrombin time, INR; hematocrit; may consider genotyping of CYP2C9 and VKORC1 prior to initiation of therapy

Sertraline

Class: Antidepressant, Selective Serotonin Reuptake Inhibitor MOA: Antidepressant with selective inhibitory effects on presynaptic serotonin (5-HT) reuptake and only very weak effects on norepinephrine and dopamine neuronal uptake. In vitro studies demonstrate no significant affinity for adrenergic, cholinergic, GABA, dopaminergic, histaminergic, serotonergic, or benzodiazepine receptors. Use: Major depressive disorder (unipolar), OCD, panic disorder, PTSD, Premenstrual dysphoric disorder, social anxiety disorder; off-label: Binge eating disorder; Body dysmorphic disorder; Bulimia nervosa; Generalized anxiety disorder; Premature ejaculation Administration: PO A/E: activation of hypomania or mania, bleeding risk, fragility fractures, hyponatremia, ocular effects, serotonin syndrome, sexual dysfunction, SI, withdrawal syndrome; >10%: GI: Diarrhea, nausea, xerostomia; Nervous system: Dizziness, drowsiness, insomnia Monitoring: Weight, height, BMI (longitudinal monitoring); closely monitor patients for depression, clinical worsening, suicidality, psychosis, or unusual changes in behavior (eg, anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, social functioning), particularly during the initial 1 to 2 months of therapy or during periods of dosage adjustments (increases or decreases); signs/symptoms of serotonin syndrome such as mental status changes (eg, agitation, hallucinations, delirium, coma), autonomic instability (eg, tachycardia, labile BP, diaphoresis), neuromuscular changes (eg, tremor, rigidity, myoclonus), GI symptoms (eg, nausea, vomiting, diarrhea), and/or seizures; serum sodium in at-risk populations.

Atorvastatin

Class: Antilipemic Agent, HMG-CoA Reductase Inhibitor MOA: Inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol synthesis; properties including improved endothelial function, reduced inflammation at the site of the coronary plaque, inhibition of platelet aggregation, and anticoagulant effects Use: Heterozygous familial hypercholesterolemia, Homozygous familial hypercholesterolemia, Prevention of atherosclerotic cardiovascular disease; off-label: Transplantation, post heart; Transplantation, post kidney Administration: PO- suspension: on empty stomach at least 1-2 hr before meals without regard to time of day; tablet: w/ or w/out food A/E: hepatic effects, muscle-related effects; >10%: GI- diarrhea; Neuromuscular & skeletal: Arthralgia; Respiratory: Nasopharyngitis Monitoring: Lipid panel (total cholesterol, HDL, LDL, triglycerides), Hepatic transaminase levels, Monitor closely for myopathy/rhabdomyolysis, CPK

Escitalopram

Class: Antidepressant, Selective Serotonin Reuptake Inhibitor MOA: Escitalopram is the S-enantiomer of the racemic derivative citalopram, which selectively inhibits the reuptake of serotonin with little to no effect on norepinephrine or dopamine reuptake Use: generalized anxiety disorder, Major depressive disorder (unipolar); off-label: Binge eating disorder; Body dysmorphic disorder; Bulimia nervosa; Obsessive-compulsive disorder; Panic disorder; Posttraumatic stress disorder; Premature ejaculation; Premenstrual dysphoric disorder; Social anxiety disorder; Vasomotor symptoms associated with menopause Administration: PO-Administer once daily (morning or evening), with or without food. A/E: activation of mania or hypomania, bleeding risk, fragility fractures, hyponatremia, ocular effects, QT prolongation, serotonin syndrome, sexual dysfunction, SI, withdrawal syndrome; >10%: GI: Diarrhea, nausea; GU: Ejaculatory disorder; Nervous system: Drowsiness, headache, insomnia Monitoring: ECG (in patients at increased risk for QT-prolonging effects); electrolytes (potassium and magnesium concentrations at baseline and as clinically indicated); liver and renal function tests (baseline; as clinically indicated); serum sodium in at-risk populations (as clinically indicated); CBC (as clinically indicated); screen all patients for any personal or family history of bipolar disorder, hypomania, or mania (prior to initiating therapy); closely monitor patients for depression, clinical worsening, suicidality, psychosis, or unusual changes in behavior, particularly during the initial 1 to 2 months of therapy or during periods of dosage adjustments; signs/symptoms of serotonin syndrome such as mental status changes, autonomic instability, neuromuscular changes, GI symptoms, and/or seizures.

Fluoxetine

Class: Antidepressant, Selective Serotonin Reuptake Inhibitor MOA: Inhibits CNS neuron serotonin reuptake; minimal or no effect on reuptake of norepinephrine or dopamine; does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors Use: bipolar disorder, Bulimia nervosa, Major depressive disorder (unipolar), Obsessive-compulsive disorder, panic disorder, Premenstrual dysphoric disorder; off-label: Binge eating disorder; Body dysmorphic disorder; Fibromyalgia, refractory; Generalized anxiety disorder; Posttraumatic stress disorder; Premature ejaculation; Selective mutism; Social anxiety disorder Administration: PO-w/out regard to food A/E: activation of mania or hypomania, bleeding risk, fragility fractures, hypersensitivity reactions, hyponatremia, ocular effects, serotonin syndrome, sexual dysfunction, SI, withdrawal; >10%: Endocrine & metabolic: Decreased libido; GI: Anorexia, diarrhea, nausea, xerostomia; GU: Sexual disorder; Nervous system: Anxiety, asthenia, drowsiness, headache, insomnia, nervousness, tremor, yawning; Respiratory: Pharyngitis Monitoring: Serum sodium in at-risk populations (as clinically indicated); blood glucose (for diabetic patients); liver and renal function; ECG assessment and periodic monitoring in patients with risk factors for QT prolongation and ventricular arrhythmia; closely monitor patients for depression, clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial 1 to 2 months of therapy or during periods of dosage adjustments; signs/symptoms of serotonin syndrome, such as mental status changes, autonomic instability, neuromuscular changes, GI symptoms, and/or seizures; akathisia; sleep status

Paroxetine

Class: Antidepressant, Selective Serotonin Reuptake Inhibitor MOA: Paroxetine is a selective serotonin reuptake inhibitor, chemically unrelated to tricyclic, tetracyclic, or other antidepressants; presumably, the inhibition of serotonin reuptake from brain synapse stimulated serotonin activity in the brain Use: Generalized anxiety disorder, Major depressive disorder (unipolar), OCD, panic disorder, PTSD, Premenstrual dysphoric disorder, Social anxiety disorder, Vasomotor symptoms of menopause; off-label: Body dysmorphic disorder; Premature ejaculation Administration: PO- May be administered without regard to meals. Administer preferably in the morning A/E: activation of hypomania or mania, bleeding risk, fragility fractures, hyponatremia, ocular effects, serotonin syndrome, sexual dysfunction, SI, withdrawal syndrome Monitoring: Liver and renal function tests (baseline; as clinically indicated); serum sodium in at-risk populations (as clinically indicated); CBC (as clinically indicated); closely monitor patients for depression, clinical worsening, suicidality, psychosis, or unusual changes in behavior (eg, anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania), particularly during the initial 1 to 2 months of therapy or during periods of dosage adjustments (increases or decreases); signs/symptoms of serotonin syndrome such as mental status changes (eg, agitation, hallucinations, delirium, coma), autonomic instability (eg, tachycardia, labile BP, diaphoresis), neuromuscular changes (eg, tremor, rigidity, myoclonus), GI symptoms (eg, nausea, vomiting, diarrhea), and/or seizures.

Trazadone

Class: Antidepressant, Serotonin Reuptake Inhibitor/Antagonist MOA: Inhibits reuptake of serotonin, causes adrenoreceptor subsensitivity, acts as a 5HT2a receptor antagonist and induces significant changes in 5-HT presynaptic receptor adrenoreceptors. Trazodone also significantly blocks histamine (H1) and alpha1-adrenergic receptors. Use: Major depressive disorder (unipolar); off-label: Aggressive or agitated behavior associated with dementia; Insomnia, sleep onset and sleep maintenance Administration: PO- Administer shortly after a meal or light snack A/E: activation of hypomania or mania, bleeding risk, cardiac arrhythmias, orthostatic hypotension, priapism, serotonin syndrome, SI, withdrawal syndrome; >10%: GI: Nausea and vomiting, xerostomia; Nervous system: Dizziness, drowsiness, fatigue, HA, nervousness; Ophthalmic: Blurred vision Monitoring: Baseline liver function prior to and periodically during therapy; closely monitor patients for depression, clinical worsening, suicidality, psychosis, or unusual changes in behavior (eg. anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania), particularly during the initial 1 to 2 months of therapy or during periods of dosage adjustments (increases or decreases); signs/symptoms of serotonin syndrome such as mental status changes (eg, agitation, hallucinations, delirium, coma); autonomic instability (eg, tachycardia, labile BP, diaphoresis); neuromuscular changes (eg, tremor, rigidity, myoclonus); GI symptoms (eg, nausea, vomiting, diarrhea); and/or seizures; signs/symptoms of hypotension or orthostasis.

Simvastatin

Class: Antilipemic Agent, HMG-CoA Reductase Inhibitor MOA: a methylated derivative of lovastatin that acts by competitively inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the enzyme that catalyzes the rate-limiting step in cholesterol biosynthesis. Use: Heterozygous familial hypercholesterolemia, Homozygous familial hypercholesterolemia, Prevention of atherosclerotic cardiovascular disease; off-label: Transplantation, post kidney Administration: PO- Administer in the evening on an empty stomach A/E: hepatic effects, muscle-related effects Monitoring: Lipid panel (total cholesterol, HDL, LDL, triglycerides), Hepatic transaminase levels, CPK

Venlafaxine

Class: Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor MOA: Venlafaxine and its active metabolite, O-desmethylvenlafaxine, are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake. Venlafaxine and ODV have no significant activity for muscarinic cholinergic, H1-histaminergic, or alpha2-adrenergic receptors. Use: Generalized anxiety disorder, Major depressive disorder (unipolar), Panic disorder, Social anxiety disorder; off-label: Migraine, prevention; Narcolepsy with cataplexy; Neuropathic pain associated with diabetes mellitus; Obsessive-compulsive disorder; Posttraumatic stress disorder; Premenstrual dysphoric disorder; Vasomotor symptoms associated with menopause Administration: PO- with food A/E: Activation of mania or hypomania, Bleeding risk, Blood pressure elevations, Fragility fractures, Hepatotoxicity, Hyponatremia, Ocular effects, Serotonin syndrome, Sexual dysfunction, Suicidal thinking and behavior, Withdrawal syndrome; >10%: Dermatologic: Diaphoresis; Endocrine & metabolic: Weight loss; GI: Anorexia, nausea, xerostomia; Nervous system: Asthenia, dizziness, drowsiness, insomnia Monitoring: BP should be regularly monitored, especially in patients with a high baseline BP pressure; may cause mean increase in heart rate of 4 to 9 beats/minute; lipid panel; screen patients for personal or family history of bipolar disorder, mania, or hypomania prior to initiating therapy; closely monitor patients for depression, clinical worsening, suicidality, psychosis, or unusual changes in behavior, particularly during the initial 1 to 2 months of therapy or during periods of dosage adjustments; signs/symptoms of serotonin syndrome such as mental status changes, autonomic instability, neuromuscular changes, GI symptoms, and/or seizures;

Amitriptyline

Class: Antidepressant, Tricyclic (Tertiary Amine) MOA: Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump. Use: major depressive disorder unipolar; off-label: Chronic fatigue syndrome-related sleep disturbances and pain; Cyclic vomiting syndrome, moderate to severe, prevention; Fibromyalgia; Functional dyspepsia; Headache, chronic tension-type (prevention); Interstitial cystitis (bladder pain syndrome); Irritable bowel syndrome-associated pain and global symptoms; Migraine, prevention; Myofascial pain syndrome and related causes of chronic pain including myofascial pelvic pain, nonradicular neck pain, temporomandibular disorders, and vulvodynia; Neuropathic pain, chronic (including diabetic neuropathy); Postherpetic neuralgia; Sialorrhea Administration: PO preferably in afternoon/night to minimize daytime sedation A/E: anticholinergic effects, bleeding risk, CNS depression, cardiac conduction abnormalities, fragility fractures, hyponatremia, ocular effects, orthostatic hypotension, serotonin syndrome, SI, withdrawal syndrome Monitoring: Serum sodium in at-risk populations (as clinically indicated); mental status and alertness; closely monitor all patients for depression, clinical worsening, suicidality, psychosis, or unusual changes in behavior (such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, and social functioning)

Metformin

Class: Antidiabetic Agent, Biguanide MOA: Decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilization) Use: Diabetes mellitus, type 2, treatment; off-label: Antipsychotic-induced weight gain; Diabetes mellitus, type 2 (prevention); Gestational diabetes mellitus (treatment); Ovarian hyperstimulation syndrome prevention in patients with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection Administration: PO- Administer with a meal (to decrease GI upset). A/E: GI effects, lactic acidosis, vitamin B12 deficiency; >10%: GI: Diarrhea, flatulence, N/V Monitoring: Urine for glucose and ketones, plasma glucose. Monitor renal function (eGFR) prior to therapy initiation and at least annually or at least every 3 to 6 months if eGFR is <60 mL/minute/1.73 m2 or at least every 1 to 3 months in patients with hepatic impairment (expert opinion). Initial and annual monitoring of hematologic parameters (eg, hemoglobin/hematocrit and red blood cell indices); monitor folate if megaloblastic anemia is suspected. Monitor vitamin B12 serum concentrations every 1 to 2 years, particularly in patients who have been treated with metformin for ≥4 years, or in patients with peripheral neuropathy, anemia, or risk factors for vitamin B12 deficiency

Furosemide

Class: Antihypertensive; Diuretic, Loop MOA: Primarily inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal and distal renal tubules, interfering with the chloride-binding cotransport system, thus causing its natriuretic effect Use: edema or volume overload Administration: PO- w/ or w/out food; parenteral, SUBQ A/E: AKI, fluid/electrolyte loss, hypersensitivity reactions, ototoxicity Monitoring: BP; serum electrolytes; kidney function; fluid intake and output.

Hydrochlorothiazide/Triamterene

Class: Antihypertensive; Diuretic, Potassium Sparing; Diuretic, Thiazide MOA: Hydrochlorothiazide: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions. Triamterene: Blocks epithelial sodium channels in the late distal convoluted tubule (DCT) and collecting duct which inhibits sodium reabsorption from the lumen. This effectively reduces intracellular sodium, decreasing the function of Na+/K+ ATPase, leading to potassium retention and decreased calcium, magnesium, and hydrogen excretion. Use: HTN, edema; off-label: Meniere disease Administration: PO w/out regard to food A/E: Monitoring: BP, serum electrolytes, BUN, creatinine, LFTs, signs of hyperkalemia.

Hydrochlorothiazide

Class: Antihypertensive; Diuretic, Thiazide MOA: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions Use: edema or general volume overload, HTN (chronic); off-label: Calcium nephrolithiasis, prevention; Diabetes insipidus, nephrogenic Administration: PO, early in the day to avoid nocturia A/E: dermatologic toxicity, electrolyte disturbances, gout, hypersensitivity reactions, ocular effects Monitoring: Blood pressure; fluid intake and output; serum electrolytes; BUN, serum creatinine; skin to assess for photosensitivity and skin cancer; visual acuity, ocular pain.

Clopidogrel

Class: Antiplatelet Agent; Antiplatelet Agent, Thienopyridine; P2Y12 Antagonist MOA: The active metabolite irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface, which prevents activation of the GPIIb/IIIa receptor complex, thereby reducing platelet aggregation. Use: acute coronary syndrome (ST-segment elevation myocardial infarction, Non-ST-segment elevation acute coronary syndromes), Myocardial infarction, ischemic stroke/transient ischemic attack, or peripheral atherosclerotic disease; off-label: Carotid artery atherosclerosis, symptomatic; Carotid artery stenting; Coronary artery bypass graft surgery; Percutaneous coronary intervention for stable ischemic heart disease; Stable ischemic heart disease; Transcatheter aortic valve replacement, thromboprophylaxis; Transcatheter mitral valve repair with MitraClip device, thromboprophylaxis Administration: PO w/out regard to food A/E: bleeding, hypersensitivity reactions, thrombotic thrombocytopenic purpura Monitoring: Signs of bleeding; hemoglobin and hematocrit periodically.

Clonazepam

Class: Antiseizure Agent, Benzodiazepine; Benzodiazepine MOA: Intermediate- to long-acting benzodiazepine. The exact mechanism is unknown, but believed to be related to its ability to enhance the activity of GABA; suppresses the spike-and-wave discharge in absence seizures by depressing nerve transmission in the motor cortex. Use: panic disorder, seizure disorder; off-label: Anxiety and agitation, acute; Anxiety disorder; Myoclonus; Rapid eye movement sleep behavior disorder; Tardive dyskinesia; Vertigo, acute episodes Administration: PO (To reduce somnolence, administration of one dose at bedtime may be desirable.) A/E: anterograde amnesia, CNS effects, paradoxical reactions, withdrawal syndrome; >10%: Nervous system: Ataxia (seizure disorder: ~30%; panic disorder: 1% to 9%) (table 1), behavioral problems (seizure disorder: ~25%), dizziness (5% to 12%), drowsiness Monitoring: Relationship between serum concentration and dose is not well established. Therapeutic doses have been associated with serum concentrations of ~20 to 70 ng/mL

Lorazepam

Class: Antiseizure Agent, Benzodiazepine; Benzodiazepine MOA: Short-to-intermediate-acting benzodiazepine (based on half-life). Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the central nervous system, including the limbic system, reticular formation. Use: anxiety (oral), Procedural anxiety, premedication (injection), Status epilepticus (injection); off-label: Akathisia, antipsychotic-induced; Alcohol withdrawal syndrome; Catatonia; Chemotherapy-induced nausea and vomiting; Intoxication: Cocaine, methamphetamine, and other sympathomimetics; Mechanically ventilated patients in the ICU, sedation; Neuroleptic malignant syndrome; Opioid withdrawal; Serotonin syndrome (serotonin toxicity); Vertigo, acute episodes Administration: IM, IV, PO (w/out regard to food), SUBQ, rectal, sublingual A/E: anterograde amnesia, CNS effects, neurodevelopmental effects in children, paradoxical reactions, propylene glycol toxicity, withdrawal syndrome; >10%: Local: Pain at injection site; Nervous system: Drowsiness, sedated state Monitoring: Respiratory and cardiovascular status, BP, heart rate, symptoms of anxiety, mental alertness.

Levetiracetam

Class: Antiseizure Agent, Miscellaneous MOA: The precise mechanism by which levetiracetam exerts its antiseizure effect is unknown. However, several studies have suggested the mechanism may involve one or more of the following central pharmacologic effects: inhibition of voltage-dependent N-type calcium channels; Use: focal (partial) onset, generalized onset- Juvenile myoclonic epilepsy, Primary generalized tonic-clonic seizures; off-label: Craniotomy, seizure prophylaxis; Status epilepticus; Subarachnoid hemorrhage (short-term seizure prophylaxis); Traumatic brain injury, severe acute (short-term seizure prophylaxis) Administration: PO- w/out regard to food; IV over 15 min A/E: CNS depression, hypersensitivity reactions, psychiatric and behavioral abnormalities; >10%: Cardiovascular: Increased blood pressure; GI: Vomiting; Infection: Infection; Nervous system: Asthenia, behavioral changes, drowsiness, fatigue, headache, irritability, psychotic symptoms; Respiratory: Nasopharyngitis Monitoring: CNS depression (impaired coordination, ataxia, abnormal gait, weakness, fatigue, dizziness, and somnolence); psychiatric and behavioral symptoms (aggression, agitation, anger, anxiety, apathy, confusion, depersonalization, depression, emotional lability, hostility, hyperkinesias, irritability, nervousness, neurosis, suicidal thoughts and personality disorder); diastolic BP in children 1 month to <4 years; CBC; signs and symptoms of hypersensitivity reaction or rash.

Gabapentin

Class: Antiseizure Agent, Miscellaneous; GABA Analog MOA: Gabapentin is structurally related to GABA. However, it does not bind to GABAA or GABAB receptors, and it does not appear to influence degradation or uptake of GABA. Use: Postherpetic neuralgia, Seizures, focal (partial) onset; off-label: Alcohol use disorder, moderate to severe (alternative agent); Alcohol withdrawal; Cough, chronic refractory; Generalized anxiety disorder; Fibromyalgia (alternative agent); Hiccups (singultus); Neuropathic pain (other than postherpetic neuralgia); Pruritus, chronic (neuropathic or malignancy related) (alternative agent); Pruritus, uremic; Restless legs syndrome; Social anxiety disorder, adjunct to antidepressants or monotherapy (alternative agent); Vasomotor symptoms associated with menopause Administration: PO- May administer without regards to meals. Administer first dose on first day at bedtime to avoid somnolence and dizziness. Dosage must be adjusted for renal function; when given 3 times daily, the maximum time between doses should not exceed 12 hours. A/E: CNS and respiratory depression, hypersensitivity reactions, neuropsychiatric effects, SI; >10%: Infection: Viral infection; Nervous system: Ataxia, dizziness, drowsiness, fatigue Monitoring: Periodic renal function, suicidality (eg, suicidal thoughts, depression, behavioral changes); mental alertness; symptoms of respiratory depression and sedation in patients with underlying respiratory disease (FDA 2019); signs and symptoms of hypersensitivity (eg. anaphylaxis/angioedema, or possible disparate manifestations associated with lymphatic, hepatic, renal, cardiac, and/or hematologic systems; fever, rash, and/or eosinophilia).

Potassium chloride

Class: Electrolyte Supplement, Oral; Electrolyte Supplement, Parenteral MOA: Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretion Use: hypokalemia treatment; off-label: Diabetic ketoacidosis or hyperosmolar hyperglycemic state, potassium management; Parenteral nutrition Administration: parenteral, do NOT give undiluted or IV push (want to avoid Extravasation) A/E: Monitoring: Electrolytes (including serum potassium, calcium, chloride, magnesium, phosphate, sodium), acid/base balance; renal function; cardiac monitor (if intermittent infusion or potassium infusion rates 0.5 mEq/kg/hour in children or >10 mEq/hour in adults); to assess adequate replacement, repeat serum potassium level 2 to 4 hours after dose; monitor potassium levels daily for treatment. Monitor IV infusion site.

Alprazolam

Class: Benzodiazepine MOA: Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the central nervous system, including the limbic system, reticular formation. Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions. This shift in chloride ions results in hyperpolarization (a less excitable state) and stabilization. Use: anxiety disorders; off-label: vertigo, acute episodes Administration: PO A/E: anterograde amnesia, CNS effects, paradoxical reactions, withdrawal syndrome; >10%-Dermatologic: Skin rash; Endocrine & metabolic: Decreased libido, weight gain, weight loss; Gastrointestinal: Constipation, decreased appetite, increased appetite, xerostomia; Genitourinary: Difficulty in micturition; Nervous system: Ataxia, cognitive dysfunction, depression, dizziness, drowsiness, dysarthria, fatigue, irritability, memory impairment, sedated state Monitoring: Respiratory and cardiovascular status; mental alertness; assess risk for abuse, misuse, and substance use disorder.

Albuterol (salbutamol)

Class: Beta2 Agonist MOA: Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate. Use: bronchospasm (asthma/exercise induced bronchospasm)l off-label: hyperkalemia (inhalation Administration: IV, oral inhalation, nebulization solution, oral A/E: cardiovascular effects (tachycardia, cardiac arrhythmias), CNS effects, paradoxical bronchospasm, nervous system- excitement, nervousness; neuromuscular & skeletal- tremor; respiratory- bronchospasm, exacerbation of asthma, pharyngitis, rhinitis, upper respiratory tract infection Monitoring: FEV1, peak flow, and/or other pulmonary function tests; BP, HR; CNS stimulation; serum glucose, serum potassium, serum creatinine; asthma symptoms; arterial or capillary blood gases (if patients condition warrants); lactate, continuous ECG monitoring

Fluticasone and Salmeterol

Class: Beta2 Agonist; Beta2-Adrenergic Agonist, Long-Acting; Corticosteroid, Inhalant (Oral) MOA: -Fluticasone: The mechanism of action for all topical corticosteroids is believed to be a combination of three important properties: Anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions. Fluticasone has extremely potent vasoconstrictive and anti-inflammatory activity. -Salmeterol: Relaxes bronchial smooth muscle by selective action on beta2-receptors with little effect on heart rate Use: asthma (maintenance/controller), COPD Administration: rinse mouth with water after use (do not swallow) to reduce risk of oral candidiasis. A/E: >10%: Central nervous system: Headache; Respiratory: Upper respiratory tract infection, pneumonia, pharyngitis Monitoring: FEV1, peak flow, and/or other pulmonary function tests; blood pressure, heart rate; CNS stimulation; glaucoma and cataracts; bone mineral density (baseline and periodically thereafter); serum potassium (hypokalemic patients); glucose (diabetic patients); glaucoma/cataracts; signs/symptoms of oral candidiasis; signs/symptoms of HPA axis suppression/adrenal insufficiency; growth (adolescents and children via stadiometry).

Alendronate sodium

Class: Bisphosphonate Derivative MOA: inhibits bone resorption via actions on osteoclasts or on osteoclast precursors; decreases the rate of bone resorption, leading to an indirect increase in bone mineral density. Use: osteoporosis, Paget disease; off-label: Osteoporosis, glucocorticoid-induced, prevention; Prostate cancer, bone loss associated with androgen deprivation therapy Administration: PO, first thing in the morning 30 min or more before first meal/drink, stay upright for 30 min or more after first meal A/E: atypical femur fractures, GI mucosal irritation, hypocalcemia, osteonecrosis of the jaw; >10%- endocrine/metabolic- decreased calcium Monitoring: Serial bone mineral density (BMD) should be evaluated at baseline and every 1 to 3 years on treatment

Fluticasone propionate (oral inhalation)

Class: Corticosteroid, Inhalant (Oral) MOA: Fluticasone belongs to a group of corticosteroids which utilizes a fluorocarbothioate ester linkage at the 17 carbon position; extremely potent vasoconstrictive and anti-inflammatory activity. The effectiveness of inhaled fluticasone is due to its direct local effect. Use: asthma (maintenance/controller); off-label: Bronchiolitis obliterans, post-hematopoietic cell transplantation; Chronic obstructive pulmonary disease, maintenance; Eosinophilic esophagitis (oral); Nonasthmatic eosinophilic bronchitis Administration: oral inhalation A/E: >10%: GI: Oral candidiasis; Nervous system: Fatigue, headache, malaise; Neuromuscular & skeletal: Arthralgia, musculoskeletal pain; Respiratory: Nasal congestion, rhinitis, sinusitis, throat irritation, upper respiratory tract infection Monitoring: Growth (adolescents and children via stadiometry); signs/symptoms of HPA axis suppression/adrenal insufficiency; signs/symptoms of oral candidiasis; possible eosinophilic conditions (including Churg-Strauss syndrome); FEV1, peak flow, and/or other pulmonary function tests; asthma symptoms; bone mineral density; hepatic impairment; glaucoma/cataracts

Prednisone

Class: Corticosteroid, Systemic MOA: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and volume of the lymphatic system; suppresses adrenal function at high doses. Use: Anti-inflammatory or immunosuppressant agent in the treatment of a variety of diseases, including allergic (eg, angioedema, contact dermatitis, new-onset urticaria), hematologic (eg, immune thrombocytopenia, warm autoimmune hemolytic anemia), dermatologic, GI, inflammatory, ophthalmic, neoplastic, rheumatic (eg, acute gout flare, vasculitis, dermatomyositis, mixed cryoglobulinemia syndrome, polyarteritis nodosa, polymyositis, polymyalgia rheumatica, rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus), autoimmune, nervous system (eg, acute exacerbations of multiple sclerosis), renal, respiratory (eg, asthma), and endocrine (eg, primary or secondary adrenocorticoid deficiency); solid organ rejection (acute/chronic). Administration: PO- Administer after meals or with food or milk to decrease GI upset. May administer antacids between meals to help prevent peptic ulcers. A/E: Adrenal suppression (tertiary adrenal insufficiency), Cardiovascular effects, CNS and psychiatric/behavioral effects, Cushingoid features/Cushing syndrome, GI effects, hyperglycemia, infection, Neuromuscular and skeletal effects, Ocular effects Monitoring: Blood pressure; weight; serum glucose; electrolytes; creatine kinase; growth in pediatric patients; presence of infection, bone mineral density; assess HPA axis suppression (eg, ACTH stimulation test, morning plasma cortisol test, urinary free cortisol test); Hgb, occult blood loss; chest x-ray (at regular intervals during prolonged therapy); IOP with therapy >6 weeks, eye examination

Zolpidem

Class: Hypnotic, Miscellaneous; Nonbenzodiazepine Benzodiazepine Receptor Agonist MOA: an imidazopyridine hypnotic that is structurally dissimilar to benzodiazepines, enhances the activity of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA), via selective agonism at the benzodiazepine-1 (BZ1) receptor; the result is increased chloride conductance, neuronal hyperpolarization, inhibition of the action potential, and a decrease in neuronal excitability leading to sedative and hypnotic effects. Use: insomnia Administration: PO- Administer immediately before bedtime due to rapid onset of action. A/E: CNS depression, complex sleep behaviors, other psychiatric/behavioral effects, SI, withdrawal; >10%: Nervous system: Dizziness, drowsiness, HA Monitoring: Daytime alertness; fall risk, respiratory rate (patients with compromised respiration); behavior profile; tolerance, abuse, and dependence; reevaluate if insomnia persists after 7 to 10 days of use.

Montelukast

Class: Leukotriene Receptor Antagonist MOA: Selective leukotriene receptor antagonist that inhibits the cysteinyl leukotriene receptor. Cysteinyl leukotrienes and leukotriene receptor occupation have been correlated with the pathophysiology of asthma, including airway edema, smooth muscle contraction, and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma. Use: Allergic rhinitis (perennial or seasonal), Asthma (maintenance therapy), Bronchoconstriction, exercise-induced (prevention); off-label: Aspirin-exacerbated respiratory disease (including aspirin challenge/desensitization); Hypersensitivity reactions, rapid chemotherapy/biologics desensitization (premedication); Infusion-related reactions, daratumumab-based regimens (premedication); Urticaria, chronic and delayed pressure Administration: PO A/E: neuropsychiatric reactions Monitoring: Neuropsychiatric events, including suicidal thinking/behavior.

Lansoprazole

Class: Proton Pump Inhibitor; Substituted Benzimidazole MOA: Decreases acid secretion in gastric parietal cells through inhibition of (H+, K+)-ATPase enzyme system, blocking the final step in gastric acid production. Use: GERD, hypersecretory conditions, peptic ulcer disease; off-label: Eosinophilic esophagitis; Stress ulcer prophylaxis in critically ill patients Administration: PO, Administer 30 to 60 minutes before a meal; best if taken before breakfast; nasogastric tube A/E: Monitoring: Patients with Zollinger-Ellison syndrome should be monitored for gastric acid output, which should be maintained at ≤10 mEq/hour during the last hour before the next lansoprazole dose; bone loss and fractures, CBC, Clostridioides difficile-associated diarrhea, liver function, kidney function, serum gastrin levels, magnesium (baseline and periodically thereafter; especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia), and calcium (baseline and periodically in patients at risk

Esomeprazole

Class: Proton Pump Inhibitor; Substituted Benzimidazole MOA: Proton pump inhibitor suppresses gastric acid secretion by inhibition of the H+/K+-ATPase in the gastric parietal cell. Esomeprazole is the S-isomer of omeprazole. Use: PO/IV: Upper GI bleed, acute, postendoscopy, Gastroesophageal reflux disease, erosive or nonerosive, Gastroesophageal reflux disease; off-label: Eosinophilic esophagitis; Peptic ulcer disease, treatment of complicated ulcers; Stress ulcer prophylaxis in critically ill patients; Treatment of NSAID-induced gastric ulcers; Upper GI bleed, acute (unknown etiology or peptic ulcer hemorrhage), pre-endoscopy Administration: PO- take at least 1 hr before eating (best if taken before breakfast); IV: may be given by injection (>3 min) or intermittent infusion (10-30min); NG tube A/E: Cutaneous lupus erythematosus, enteric infections, fractures, fundic gland polyps, hypersensitivity reactions, hypomagnesemia, interstitial nephritis, vitamin B12 deficiency; >10%: Nervous system: Headache Monitoring: Susceptibility testing recommended in patients who fail H. pylori eradication regimen. Monitor for rebleeding in patients with upper GI bleeding or peptic ulcer bleed. Magnesium (baseline and periodically thereafter; especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia), calcium (baseline and periodically in patients at risk [eg, hypoparathyroidism]); signs or symptoms of cutaneous lupus erythematosus or systemic lupus erythematosus; C. difficile-associated diarrhea; bone loss and fractures

Pantoprazole

Class: Proton Pump Inhibitor; Substituted Benzimidazole MOA: Proton pump inhibitor, suppresses gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump Use: PO/IV: GERD; off-label: Aspiration prophylaxis in patients undergoing anesthesia; Barrett esophagus; Dyspepsia, functional (idiopathic or non-ulcer); Eosinophilic esophagitis; Helicobacter pylori eradication; Nonsteroidal anti-inflammatory drug (including aspirin)-induced ulcers, primary prevention; Peptic ulcer disease, maintenance therapy/secondary prevention; Peptic ulcer disease, treatment of complicated ulcers; Peptic ulcer disease, treatment of uncomplicated ulcers; Stress ulcer prophylaxis in select critically ill patients; Upper GI bleed, acute Administration: IV, PO- Should be swallowed whole, do not split, crush, or chew. For most indications, administer 30 to 60 minutes before a meal; best if taken before breakfast A/E: Cutaneous and systemic lupus erythematosus, enteric infections, fractures, hypersensitivity, fundic gland polypys, hypomagnesemia, interstitial nephritis, vitamin B12 deficiency; >10%: nervous system- HA Monitoring: Bone loss and fractures (especially in patients on high-dose or long-term therapy [≥1 year]), Clostridioides difficile-associated diarrhea (CDAD), magnesium (baseline and periodically thereafter; especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia), calcium (baseline and periodically in patients at risk (eg, hypoparathyroidism), and serum gastrin levels; signs or symptoms of cutaneous lupus erythematosus or systemic lupus erythematosus.

Cyclobenzaprine

Class: Skeletal Muscle Relaxant MOA: Centrally-acting skeletal muscle relaxant pharmacologically related to tricyclic antidepressants; reduces tonic somatic motor activity influencing both alpha and gamma motor neurons Use: muscle spasm; off-label: Fibromyalgia; Temporomandibular disorder, acute Administration: PO same time each day A/E: anticholinergic effects, CNS depression, serotonin syndrome; >10%: GI- Xerostomia, nervous system: dizziness/drowsiness Monitoring: Mental alertness; signs/symptoms of serotonin syndrome (especially during initiation/dose titration) such as mental status changes (eg, agitation, hallucinations), autonomic instability (eg, tachycardia, labile BP, diaphoresis), neuromuscular changes (eg, tremor, rigidity, myoclonus), GI symptoms (eg, nausea, vomiting, diarrhea), and/or seizures.

Levothyroxine

Class: Thyroid Product MOA: a synthetic form of thyroxine, an endogenous hormone secreted by the thyroid gland. T4 is converted to its active metabolite, L-triiodothyronine (T3). Thyroid hormones (T4 and T3) then bind to thyroid receptor proteins in the cell nucleus and exert metabolic effects through control of DNA transcription and protein synthesis; Use: PO- hypothyroidism; injectable: Treatment of myxedema coma; off-label: Deceased organ donor management (hormonal resuscitation for the deceased organ donor); Subclinical hypothyroidism Administration: PO- Administer consistently in the morning on an empty stomach, at least 30 to 60 minutes or 15 minutes before food; nasogastric tube; parenteral A/E: cardiovascular effects- palpitations, tachycardia, dyspnea on exertion Monitoring: Heart rate, BP, new/worsened cardiac symptoms (eg, chest pain, palpitations, edema), clinical signs of hypo- and hyperthyroidism; bone mineral density (particularly with long-term use in postmenopausal patients).