# data[].attributes.attachment_caption
OVERVIEW: These are drugs that help treat, prevent, and relieve the symptoms of Gout.

# data[].attributes.body
Common Drugs: Indocin, Zyloprim, Colcrys, and Uloric.

Mechanism of Action: Reduce uric acid production in the body to prevent the formation of crystal formation and inflammation

Indications: For inflammation caused by gout and the treatment of gout

Side Effects: N/V, diarrhea, stomach upset, drowsiness are the common side effects. The more severe and rarer ones are a rash, stroke, liver toxicity, and heart related problems.

Patient Considerations: When a patient has gout they should take care to avoid diuretics, alcohol, aspirin, niacin, red meat, organ meats, and sugary sodas because they could make the gout worse.

Drug Interactions: Use caution when taking Allopurinol with BP medications, warfarin, and penicillins.

LINKS:

https://www.goodrx.com/allopurinol/interactions

https://www.rxlist.com/how_do_antigout_agents_work/drug-class.htm#:~:text=Antigout%20agents%20work%20in%20the,also%20found%20in%20many%20foods.

# data[].attributes.body
ACE Inhibitors

Overview: What is this medication class, and what does it treat?

ACE Inhibitors are a type of drug called angiotensin-converting enzyme inhibitors and they are commonly used to treat high blood pressure and heart failure.

Common Drugs: List a few examples of drugs within this class.

Some examples include benazepril, lisinopril, enalapril, and ramipril

Mechanism of Action: How do these medications work in the body?

ACE Inhibitors work by blocking the activity of angiotensin converting enzymes and prevents angiotensin 1 from turning into angiotensin 2 which is an enzyme that acts as a vasoconstrictor and  narrows the blood vessels.

Indications: What conditions or diseases are these medications used to treat?

Some conditions and diseases that ACE Inhibitors treat include hypertension, heart failure, and coronary artery disease.

Side Effects: What are the common and severe side effects?

Some common side effects include dry cough, low blood pressure (hypotension), dizziness, headache, fatigue, and swelling (angioedema).

Patient Considerations: Are there any important factors or precautions a pharmacist should be aware of when dispensing these medications?

Some things that pharmacists should look out for include angioedema which can be life threatening, hyperkalemia as high potassium levels can disrupt normal heart rhythms, renal impairment as they can worsen kidney disease, and hypotension as they work by lowering blood pressure.

Drug Interactions: What other medications can interact with these drugs? What should pharmacists monitor?

Some drug interactions include potassium sparing diuretics which combined with ACE inhibitors can cause hyperkalemia, NSAIDS which decrease the effectiveness of ACE inhibitors by increasing angiotensin 2 production, and ARBs which combined with ACE inhibitors can cause hypokalemia, hypotension, and kidney damage

link:https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480#:~:text=These%20medicines%20are%20commonly%20used%20to%20treat,angiotensin%202%2C%20which%20makes%20blood%20vessels%20narrow.

# data[].attributes.body
Treats / Indications : Alzheimer's, Parkinson's Disease

Common Drugs : memantine (Namenda), rivastigmine (Exelon)

MOA : cholinesterase inhibitors

inhibit the breakdown of acetylcholine (important for memory, judgement, thinking, language)

MOA : memantine

limits glutamate cell interactions (Alzheimer's causes glutamate overactivity, damaging nerve cells and causing irregular interaction), slows memory degeneration, and protects nerve cells

Side Effects : N/V, insomnia, mood changes, dizziness, drowsiness, HA, constipation, rash, loss of appetite, weight loss, confusion, diarrhea

Patient Considerations : start off with low doses and titrate up, monitor side effects, may cause allergic reactions

Drug Interactions : anticholinergics, antihistamines, antipsychotics, tricyclic antidepressants

https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103

https://www.nia.nih.gov/health/alzheimers-treatment/how-alzheimers-disease-treated#:~:text=symptoms%20and%20antipsychotics.-,Dosage%20and%20side%20effects%20of%20Alzheimer's%20disease%20medications,adding%20or%20changing%20any%20medications.

https://pubmed.ncbi.nlm.nih.gov/12710863/#:~:text=Abstract,in%20combination%20with%20other%20medications.

# data[].attributes.attachment_link.readable_text
Alzheimer's: Drugs help manage symptoms

Alzheimer's still has no cure, but two types of drugs can help manage symptoms of the disease.
By Mayo Clinic Staff
Learning you have Alzheimer's disease can be devastating. Working with your health care team can help you find the best strategies to manage your symptoms and prolong your independence.

Alzheimer's drugs might be one strategy to help you temporarily manage memory loss, thinking and reasoning problems, and day-to-day function. Unfortunately, Alzheimer's drugs don't work for everyone, and they can't cure the disease or stop its progression. Over time, their effects wear off.

Research into more-effective Alzheimer's drugs is ongoing. If you can't take the approved medications or they don't work for you, ask your doctor if you might be eligible for a clinical trial.

Role of current Alzheimer's drugs

The Food and Drug Administration (FDA) has approved two types of drugs specifically to treat symptoms of Alzheimer's disease.

Cholinesterase inhibitors

Memantine

These drugs:

Are approved for specific Alzheimer's stages. These stages - mild, moderate and severe - are based on scores on tests that assess memory, awareness of time and place, and thinking and reasoning.

Doctors might, however, prescribe Alzheimer's drugs for stages other than those for which the FDA has approved them. Alzheimer's stages aren't exact, individual responses to drugs vary and treatment options are limited.

If your doctor prescribes medication as part of your Alzheimer's care plan, make sure you understand the drug's potential benefits and risks for your situation.

Are not approved for mild cognitive impairment (MCI). This condition, which involves subtle changes in memory and thinking, can be a transitional stage between normal age-related memory changes and Alzheimer's disease. Many people with MCI - but not all - eventually develop Alzheimer's or another dementia.

Clinical trials testing whether Alzheimer's drugs might prevent progression of MCI to Alzheimer's have generally shown no lasting benefit.

Cholinesterase inhibitors

One way Alzheimer's disease harms the brain is by decreasing levels of a chemical messenger (acetylcholine) that's important for alertness, memory, thought and judgment. Cholinesterase (ko-lin-ES-tur-ays) inhibitors boost the amount of acetylcholine available to nerve cells by preventing its breakdown in the brain.

Cholinesterase inhibitors can't reverse Alzheimer's disease or stop the destruction of nerve cells. These medications eventually lose effectiveness because dwindling brain cells produce less acetylcholine as the disease progresses.

Common side effects can include nausea, vomiting and diarrhea. Starting treatment at a low dose and working up to a higher dose can help reduce side effects. Taking these medications with food also might help minimize side effects.

People with certain types of cardiac arrhythmias shouldn't take cholinesterase inhibitors.

Three cholinesterase inhibitors are commonly prescribed:

Donepezil (Aricept) is approved to treat all stages of the disease. It's taken once a day as a pill.

Galantamine (Razadyne) is approved to treat mild to moderate Alzheimer's. It's taken as a pill once a day or as an extended release capsule twice a day.

Rivastigmine (Exelon) is approved for mild to moderate Alzheimer's disease. It's taken as a pill. A skin patch is available that can also be used to treat severe Alzheimer's disease.

Memantine for later stages

Memantine (Namenda) is approved by the FDA for treatment of moderate to severe Alzheimer's disease. It works by regulating the activity of glutamate, a messenger chemical widely involved in brain functions - including learning and memory. It's taken as a pill or syrup. Common side effects include dizziness, headache, confusion and agitation.

The FDA has also approved a combination of donepezil and memantine (Namzaric), which is taken as a capsule. Side effects include headache, dizziness, nausea and diarrhea.

When to discontinue Alzheimer's drugs

Because Alzheimer's is a progressive disease, your symptoms and care plan will change over time. If you're taking an Alzheimer's drug, ongoing review of your care plan will include working with your doctor to decide how long you should continue your medication.

Because the effects of Alzheimer's drugs are usually modest, it might be difficult to tell if the drugs are working. However, you can't know if your symptoms might be more severe without your medication.

Talk to your doctor before stopping an Alzheimer's drug, and let your doctor know if your condition worsens after you stop.

Get the latest health information from Mayo Clinic's experts.

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

Email field is required

Include a valid email address

Learn more about Mayo Clinic's use of data.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing

Our Housecall e-newsletter will keep you up-to-date on the latest health information.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Show references

1. Alzheimer's disease medications fact sheet. National Institute on Aging. https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-sheet. Accessed April 28, 2017.

2. Medications for memory loss. Alzheimer's Association. http://www.alz.org/alzheimers_disease_standard_prescriptions.asp?utm_source=google&utm_medium=search&utm_campaign=google-grants&set.custom.wt=google-grants&gclid=Cj0KEQjwioHIBRCes6nP56Ti1IsBEiQAxxb5G7qPnhb27QToNOQ-RpLk1DxwIhcRD9BIf7U_tluJv3AaAjzd8P8HAQ. Accessed April 28, 2017.

3. Mild cognitive impairment. Alzheimer's Association. http://www.alz.org/dementia/mild-cognitive-impairment-mci.asp. Accessed April 30, 2017.

4. Press D, et al. Treatment of dementia. https://www.uptodate.com/home. Accessed April 28, 2017.

See more In-depth

# data[].attributes.attachment_link.title
How Alzheimer's drugs help manage symptoms

# data[].attributes.attachment_link.description
Alzheimer's still has no cure, but two types of drugs can help manage symptoms of the disease. By Mayo Clinic Staff Learning you have Alzheimer's disease can be devastating. Working with your health care team can help you find the best strategies to manage your symptoms and prolong your independence.

# data[].attributes.body
Insulin as a class is a pharmaceutical preparation of the hormone insulin. It treats hyperglycemia and is used by patients that have type 1 and 2 diabetes.

Some common drugs include Novolog, Humalog, Apidra, Lantus, Humulin, and Levemir.

Insulin mimics your body's natural insulin to lower blood sugar levels.

Side effects include hypoglycemia, weight gain, injection site pain, sweating, shaking, and change in your vision.

Some things that the patient and physician should take into consideration before prescribing insulin:

Should the patient take long, intermediate, or short acting insulin?

What is the patients diagnosis?

How does their body produce/react to insulin?

How much insulin will be needed to accommodate the patients diet?

Some drug interactions to look out for:

Alcohol - interferes with liver's ability to produce glucose.

Estrogen - decreases effectiveness of insulin

Macrolides - increases insulin resistance

https://www.goodrx.com/classes/insulins/interactions

https://www.drugs.com/drug-class/insulin.html

https://www.healthline.com/health/diabetes/medications-list

# data[].attributes.attachment_link.readable_text
Key takeaways:

Insulin is a common medication used to treat diabetes. While there are several different types of insulin available, they all have similar interactions with other medications.

Combining insulin with medications like beta blockers, certain antibiotics, and other diabetes medications can increase the risk of low blood glucose. Beta blockers can even hide symptoms of low blood glucose, making the combination more dangerous.

Other medications -- like thiazide diuretics, atypical antipsychotics, and corticosteroids -- can weaken insulin's effects by raising blood glucose levels.

Access savings on related medications

towfiqu ahamed/iStock via Getty Images Plus

is a life-saving medication. Approximately 6 million people in the U.S. take it on a daily basis to manage diabetes.

If this includes you or a loved one, you know that several types of insulin are available to choose from. They differ from one another in how fast they start working and how long their effects last. The type of insulin that's recommended for you depends on certain factors, like your blood glucose (sugar) levels, lifestyle habits, and the type of diabetes you have.

While differences between insulins can be complex, they share at least one common feature: interactions with other medications. Often, the result of these interactions is that they lower your blood sugar too much. Sometimes this may just require caution, but other medications should be avoided altogether if you're using insulin. Below, we'll discuss seven of the most notable insulin interactions and how you might manage them.

Promotional Disclosureinfo_outlined

Save every month on GLP-1 meds with GoodRx

Save an average of $235 on FDA-approved GLP-1s like Ozempic and Zepbound.

But keep in mind: This list doesn't include every possible interaction. Always provide a complete medication list to your healthcare provider and pharmacist so they can check for other possible interactions.

1. Rosiglitazone

Read more like this

Explore these related articles, suggested for readers like you.

2. Other diabetes medications

It's important to be cautious when taking insulin with other injectable or diabetes medications. Even if these medications work in different ways, they have the same goal - to lower blood glucose. When they're combined, the effects may be too strong.

Taking insulin with any of the following medications can raise the risk of hypoglycemia:

It's common to take one or more of these medications with insulin if you have Type 2 diabetes. The combination may help you reach your blood glucose and . Your A1C is an average reading of your blood glucose control over the last 2 to 3 months.

Still, it's important to remember that there's a higher risk of hypoglycemia compared to taking these medications alone. The best way to handle this concern is to check your blood glucose routinely and keep your healthcare provider in the loop. Also be aware of possible symptoms of hypoglycemia, such as hunger, a fast heartbeat, and feeling shaky.

3. Beta blockers

Beta blockers are medications used to treat certain heart conditions, migraines, and tremors. Some examples include (Tenormin), carvedilol (Coreg), and propranolol. When taken with insulin, beta blockers can sometimes weaken insulin's effects. In other cases, they can make its effects too strong - this can lead to hypoglycemia.

Beta blockers can also (mask) symptoms of low blood glucose, like fast heart beat, tremors, and irritability. This makes it harder to know if your blood glucose levels are lower than they should be.

If you take both insulin and a beta blocker, it's important to check your blood glucose regularly, especially since classic hypoglycemia symptoms may be harder to recognize. Make sure you're able to recognize low blood glucose readings on your glucometer and also when you feel hungry or sweaty. Beta blockers don't mask these two hypoglycemia symptoms.

4. Certain antibiotics

Sulfa antibiotics, such as (sulfamethoxazole/trimethoprim), can also cause low blood glucose when taken with insulin.

If you're planning to take one or more of these antibiotics while taking insulin, talk to your healthcare provider first. If they're combined, you may need to track your blood glucose more closely or change your insulin dose.

5. Thiazide diuretics

These diuretics can affect how your body reacts to insulin. They can weaken its effects. When taken together, the combination can raise your blood glucose and lead to worse diabetes control.

If you're taking a thiazide diuretic with insulin, make sure to check in with your healthcare provider. They may need to increase your insulin dose depending on how high or low your blood glucose levels are.

6. Medications that raise your blood glucose levels

When combined with other medications that can raise your blood glucose levels, your healthcare provider may need to watch your blood glucose more closely and adjust your insulin doses as needed.

7. Alcohol

Drinking alcohol can affect your diabetes management. If you have diabetes, drinking any amount of alcohol raises the risk of low blood glucose. That's because when you drink, your liver is focused on breaking down the alcohol rather than making glucose.

Taking insulin and alcohol together further worsens this risk. Because of this, it's best to avoid alcohol when taking insulin.

However, since alcohol is a common staple of social gatherings, this isn't always feasible. If you decide to drink alcohol, make sure to talk to your healthcare provider first. They can suggest tips on ways to drink moderate amounts of alcohol in a safe manner.

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

Was this page helpful?

Learn How to Lower Your A1C

Join our 12-week newsletter series that has the lifestyle, diet, and medication information you need to help lower your A1C.

By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.

# data[].attributes.attachment_link.title
The 7 Most Common Insulin Interactions You Should Heed Caution With - GoodRx

# data[].attributes.attachment_link.description
Taking insulin with alcohol and beta blockers may affect glucose levels and cause increased side effects. See more insulin interactions here.

# data[].attributes.body
NSAIDs treat inflammation, pain, or fever. Drugs within this class include ibuprofen (Advil/Motrin), meloxicam (Mobic), celecoxib (Celebrex), naproxen (Aleve/Naprosyn), diclofenac (Voltaren), and nabumetone (Relafen). NSAIDs work by inhibiting the COX enzymes which convert arachidonic acid into thromboxanes: which cause inflammation to help stop bleeding, prostaglandins: which cause vasodilation increasing temperature, and prostacyclins—reducing inflammation, pain, and fever. COX-1 is naturally expressed in the body and helps maintain GI lining, kidney function, and platelet aggression. COX-2 is expressed during the inflammatory response. ibuprofen (Advil/Motrin), meloxicam (Mobic), naproxen (Aleve/Naprosyn), diclofenac (Voltaren), and nabumetone (Relafen) are non-selective NSAIDs that work on the prostaglandins decreasing temperature, pain, and inflammation. However, Celebrex works differently: it is a COX-2 inhibitor and decreases inflammation without compromising gastric mucosa. NSAIDs are indicated for pain, fever, inflammation, and chronic pain. Side effects include: abdominal pain, diarrhea, upset stomach, dark stool, hypertension, tinnitus, and dizziness. They should not be taken with other NSAIDS, aspirin, beta-blockers, digoxin, warfarin, diuretics, or oral hypoglycemic. Patients should be warned that the non-selective NSAIDs cause a lot of GI side effects and NSAIDs are contraindicated with pregnancy, blood thinners, patients with a history of (stomach ulcers, kidney, and liver) abnormalities, and patients allergic to aspirin. They should also be aware that celebrex can cause fluid retention and they should avoid taking them before and after coronary artery bypass surgery.

Links: https://www.ncbi.nlm.nih.gov/books/NBK547742/

.

# data[].attributes.body
Overview: What is this medication class, and what does it treat?

ARBS (Angiotensin receptor blockers), used to treat hypertension and congestive heart failures, but also prevents, treats, or improves symptoms of chronic kidney failure, heart failure, and kidney failure due to diabetes.

Common Drugs: List a few examples of drugs within this class.

Azilsartan (Edarbi).

Candesartan (Atacand).

Irbesartan (Avapro).

Losartan (Cozaar).

Olmesartan (Benicar).

Telmisartan (Micardis).

Valsartan (Diovan)

Mechanism of Action: How do these medications work in the body?

The drug inhibits the action of Angiotensin ll, this enzyme allows the blood vessels to narrow, while inhibiting them the blood vessels become relaxed. Blood pressure will be lowered and more oxygen-rich blood can reach the heart.

Indications: What conditions or diseases are these medications used to treat?

Hypertension, congestive heart failure.

Side Effects: What are the common and severe side effects?

Some common side effects of ARBs consist of: HA, drowsiness, dizziness, too much potassium in the blood, edema caused by extra fluid in the skin. Serious side effects include: digestive problems, severe diarrhea, and an excess amount of weight loss.

Patient Considerations: Are there any important factors or precautions a pharmacist should be aware of when dispensing these medications?

Patients should not take ARBs if pregnant or trying to get pregnant, as it can harm the fetus and affect growth in the womb. Tell your doctor all of your medical history before taking ARBs, including: allergies, if you had previous reactions to ARBs, breast-feeding, if you have kidney disease, liver disease, and congestive heart failure, or if you tend to get dehydrated easily.

Drug Interactions: What other medications can interact with these drugs? What should pharmacists monitor?

Patients should not take diuretics, ACE inhibitors, potassium supplements, calcium channel blockers, and NSAIDS. Pharmacists should monitor blood pressure, potassium and renal function, looking for side effects like hyperkalemia, renal impairment, and hypotension.

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/angiotensin-ii-receptor-blockers/art-20045009

https://www.texasheart.org/heart-health/heart-information-center/topics/angiotensin-ii-receptor-blockers/

# data[].attributes.body
Treats/Indications

Depression

Generalized Anxiety Order (GAD)

PTSD

OCD

Fibromyalgia

Common Drugs

Citalopram (Lexapro)

Escitalopram (Celexa)

Sertraline (Zoloft)

Mechanism of Action

Blocks the reabsorption of serotonin in the brain, making more serotonin available

Side Effects

N/V, Anxiety, HA, Diarrhea, Weight Loss

BW:

Increased risk of suicidal thoughts and behaviors

A sudden stop of use may cause withdrawal symptoms

Drug Interactions

Alcohol and Benzos cause increased sedation effects

Warfarin causes an increased anticoagulant effect

# data[].attributes.body
What: They are a class of antibiotics that treat bacterial infections. They can be an alternative for penicillins if are allergic.

MOA: Their MOA is inhibiting RNA-dependent protein synthesis.

Ex: Azithromycin, Clarithromycin are examples.

Treats: They treat pneumonia, strep throat, and other bacterial infections.

Side effects: nausea, vomiting, and diarrhea. Stevens- Johnson syndrome is a rare but serious side effect of Macrolides.

Drug interactions: alcohol, statins, warfarin, and benzodiazepines.

Patient counseling: should be aware of the variety of GI and CV effects that they could encounter.

https://my.clevelandclinic.org/health/treatments/macrolides

https://www.ncbi.nlm.nih.gov/books/NBK551495/#:~:text=Go%20to%3A-,Mechanism%20of%20Action,cessation%20of%20bacterial%20protein%20synthesis.

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/drug-interactions/macrolides.html

# data[].attributes.body
Type 2 Diabetes - Metabolic disorder characterized by insulin resistance

Common Drugs - Glyburide (Diabeta), Glipizide (Glucotrol), Glimepiride (Amaryl)

Mechanism of Action - Promotes the release of insulin from the pancreas which directly lowers blood glucose levels. Sulfonylureas bind to the SUR1 receptors in the membranes of the beta cells of potassium ATP-dependent channels.

Indications - Type 2 diabetes only and help controls blood sugar

Side Effects - Risk of hypoglycemia and nausea

Patient Considerations - Take with food, kidney and liver disease

Drug Interactions - Low risk of cross sensitivity to sulfa allergy

https://www.ncbi.nlm.nih.gov/books/NBK545313/

# data[].attributes.attachment_link.readable_text
Continuing Education Activity

According to the 2023 update of the American Diabetes Association Standards of Medical Care in Diabetes, glyburide and other sulfonylureas are considered viable options for adjunctive therapy, particularly for patients seeking potent agents with a higher chance of attaining glycemic targets. This comprehensive overview of glyburide focuses on its indications, mechanism of action, contraindications, adverse event profile, and monitoring considerations. This activity emphasizes the importance of glyburide as an effective therapeutic option in managing type 2 diabetes for interprofessional team members involved in patient care.

Objectives:

Identify patients with type 2 diabetes who may be appropriate candidates for glyburide therapy, considering factors such as glycemic control, renal function, and medication history.

Screen patients for contraindications and potential risks associated with glyburide, such as renal impairment or a history of hypoglycemia.

Assess the effectiveness of glyburide therapy in achieving glycemic control, monitoring blood glucose levels, and adjusting the treatment plan as needed.

Collaborate with other healthcare professionals, such as endocrinologists, pharmacists, and diabetes educators, to ensure comprehensive diabetes care and optimize the use of glyburide.

Access free multiple choice questions on this topic.
Indications

Glyburide, or glibenclamide, is a second-generation sulfonylurea approved by the Food and Drug Administration (FDA) for treating type 2 diabetes. The medication is available as a generic formulation. Glyburide is an adjunct therapy along with diet and exercise for managing diabetes.[1] Treatment with glyburide has and continues to lower blood glucose levels successfully and is also available in combination formulation with metformin. Typical doses for glyburide are relatively minute compared to first-generation sulfonylureas, and dosing is usually a once-daily morning dose.[1]

FDA-Approved Indications

According to the American Diabetes Association (ADA) Standards of Medical Care in Diabetes 2023 update, sulfonylureas such as glyburide are considered one of the multiple options for adjunctive therapy, especially for patients seeking highly efficacious agents with a greater likelihood of achieving their glycemic goals.[2] This recommendation focuses on patients with type 2 diabetes mellitus who do not have atherosclerotic cardiovascular disease or chronic kidney disease and have not achieved their HbA1C target despite exhausting first-line treatment options.[2] However, recent updates in recommendations for first-line therapy emphasize the importance of tailoring treatment based on patient-specific factors, including comorbidities such as atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, as well as individual management needs.[2]

Off-Label Uses

For many years, glyburide has been studied off-label for treating neonatal syndromic hyperglycemia for patients with KCNJ11 or ABCC8 mutations that encode subunits of the ATP-sensitive K⁺ (K ATP) channel gene.[3] Although no dose forms are available for children with these potassium channel defects, studies have included a newly-designed suspension with orphan drug status to evaluate its efficacy against glyburide tablets.[4] Results from the research reflected significant decreases in HbA1C levels, further warranting this off-label use.[4]

Due to glyburide's sulfonylurea receptor 1 (SUR1) receptor-blocking action, recent studies have shed light on the potential of low doses of glyburide as a possible agent for reducing intracranial pressure and cerebral edema.[5]

Mechanism of Action

Glyburide, along with others in the sulfonylurea class, exerts its mechanism of action based on increasing insulin secretion from beta cells in the pancreas.[6] Specifically, sulfonylureas bind to the SUR1 receptors in the membranes of the beta cells of potassium ATP-dependent channels.[6][7]

These agents block these channels, releasing insulin after the cell depolarizes.[8] At times, sulfonylureas bind to SUR2 receptors on cells in cardiac tissue and the endothelium.[7]

After the initial insulin secretion, sulfonylureas can also decrease insulin clearance in the liver, increasing plasma insulin levels.[9] Glyburide, along with glipizide, is classified as a second-generation sulfonylurea due to its increased potency and difference in elimination, allowing their use in patients with renal and hepatic dysfunction.

Pharmacokinetics

Glyburide is metabolized in the liver via the CYP450 system; it is a CYP2C9 substrate. The drug has a half-life of 10 hours and is excreted in the bile (50%) and urine (50%).

Administration

Glyburide is available in 1.25 mg, 2.5 mg, and 5 mg tablets.

Dosage for type 2 diabetes: 1.25 mg to 20 mg orally, once or divided twice daily.

Formulation note: non-micronized and micronized glyburide formulations are not bioequivalent. Dosing must be re-titrated when switching between formulations.

Glyburide is orally administered in typical initial dosages of 2.5 mg to 5 mg, with a maximum of 40 mg daily-the maximum dosage is rarely used, as many patients with type 2 diabetes do not require dosages higher than 10 mg per day.[1] Clinical effects are also insignificant beyond dosages of 10 to 15 mg daily.[1][9]

To optimize absorption and maximize the antidiabetic effect of sulfonylureas, including glyburide, it is recommended to take them orally approximately 30 minutes before meals, as food intake and hyperglycemia may potentially decrease their absorption.[1] Patients should take lower doses of glyburide (≤10 mg) with breakfast or as soon as the patient consumes the breakfast meal, with higher daily doses (>10 mg) usually divided between breakfast and evening meals.[1]

Renal dosing: CrCl <60; avoid use. Avoid use in patients on dialysis.

Hepatic dosing: Start dosing at 1.25 mg in patients with hepatic impairment.

Pregnancy: Multiple studies have examined glyburide use in pregnant patients with gestational diabetes. Although the FDA considers glyburide a Category C drug, expert bodies have started to introduce introducing glyburide as a possible alternative to insulin for antidiabetic therapy. Glyburide crosses the placenta in utero and is metabolized by placental microsomes, exposing the fetus to the medication.

Lactation: Concerning lactation, both glyburide and its second-generation counterpart, glipizide, are compatible with breastfeeding as they do not transfer into breast milk or pose no known risk of harm to breastfed infants.[7]

Adverse Effects

Adverse Drug Reactions

Hypoglycemia and weight gain are the most frequently encountered adverse effects of glyburide. Although glyburide is one of the most popular sulfonylureas prescribed, a systematic review conducted by the ADA found evidence suggesting that glyburide correlates with a significantly higher risk of hypoglycemic episodes than other insulin secretagogues sulfonylureas by 80% and 44%, respectively.[10] However, these episodes are most often seen with higher initial glyburide dosing and in patients recently diagnosed, especially those 65 years and older.[1] For this reason, clinicians must consider patient-specific factors and susceptibility to hypoglycemic episodes when considering a glyburide prescription for a sulfonylurea-naïve patient.

Due to the risk of severe prolonged hypoglycemia with long-acting sulfonylureas (and subsequent risk for falls), glyburide is listed on the 2019 American Geriatrics Society Beers Criteria as a potentially inappropriate medication in those aged 65 and older.[11]

The ADA Standards of Medical Care in Diabetes 2023 update also considers long-acting sulfonylureas, such as glyburide, as agents to avoid in older adults due to the risk of hypoglycemia and advises against the drug's use in this population. Treatment with glyburide in this at-risk patient population, especially those with more advanced age and complex medical conditions, is considered "overtreatment" per the ADA. Therefore, treatment de-intensification should be considered via dose reduction, discontinuation, or utilization of lower-risk agents, as long as individualized glycemic targets are continually achieved.[12]

Possible weight gain can also be a distressing adverse effect for patients taking glyburide, as with all sulfonylureas. According to the ADA's systematic review, glyburide is less significantly associated with weight gain than other insulin secretagogues. However, if weight gain does occur, coadministration with metformin, a weight-neutral biguanide agent, can be considered to address this issue.[1][10]

A cohort study on patients with type 2 diabetes compared all-cause and cardiovascular mortality for patients on either glyburide or metformin for blood glucose management.[13] The study found that glyburide monotherapy, compared to metformin, was associated with higher percentages of all-cause (6.3% and 1.6%, respectively) and cardiovascular (4.1% and 0.4%, respectively) deaths, in addition to increases in plasma creatinine. Other nationwide studies, retrospective cohort studies, and other recent studies have confirmed metformin as having lower all-cause mortality rates and higher survival rates than glyburide and other drugs of its class.[13]

Adverse effects that are less likely to occur with glyburide and other sulfonylureas include skin rashes, nausea, and sensitivity to light on rare occasions.[9]

Drug-Drug Interactions

Concurrent use of glyburide with bosentan is contraindicated.

Monitoring for potentially harmful drug-drug interactions is crucial when patients receive concurrent therapy with salicylates, sulfonamides, drugs containing fibric acid, and warfarin.[9] Additional medications that may inhibit or induce CYP2C9 include azole antifungals, carbamazepine, phenobarbital, rifampin, St. Johns wort, and dexamethasone. The most beneficial way to mitigate sulfonylurea and glyburide toxicity is to elevate the patient's blood glucose level back to its normalized range, depending on the setting.[13]

Contraindications

Glyburide has no boxed warnings.

Contraindications

Glyburide therapy should not be re-initiated if the patient has a history of allergic reaction to the medication. However, patients with previous allergic reactions to drugs of the same class may not necessarily react to glyburide.[1]

Also, prescribers must use caution with glyburide in hospitalized patients, who are malnourished, misuse alcohol, have renal and cardiac dysfunctions, or with gastrointestinal disease.[9]

Monitoring

As glyburide rates for hypoglycemia can be higher than other oral antidiabetic agents, close monitoring for signs and symptoms of declining blood glucose levels is required. Hypoglycemia can be life-threatening, and it is crucial to take proper measures if the condition occurs in any patient. Monitoring glyburide is also necessary for patients in circumstances that provoke the onset of hypoglycemia, including exercise, lack of eating, and accidental overdosage.[9]

To ensure patient safety, it is crucial to be aware of the signs and symptoms of hypoglycemia when initiating glyburide therapy. Patients should be educated on self-monitoring of blood glucose levels and adhere to regularly scheduled blood glucose and HbA1C testing as the ADA recommends.

Glyburide and other sulfonylureas may also cause liver dysfunction, potentially resulting in cholestatic jaundice, hepatitis, and liver failure, although this is rare.[9] In patients with liver dysfunction, monitoring of liver function tests may be necessary.

Toxicity

Glyburide toxicity is primarily associated with the risk of severe hypoglycemia due to an excessive dosage, whether it occurs accidentally or intentionally.[9][13] Due to duplicate metabolism involving the CYP2C9 enzyme, drug-drug interactions between glyburide and other sulfonylureas can also potentiate hypoglycemia.[13]

Enhancing Healthcare Team Outcomes

The interprofessional healthcare team, including clinicians and pharmacists, must work together to ensure that the best possible treatment outcomes occur in patients with type 2 diabetes. Consistent monitoring of blood glucose and HbA1C levels is vital in determining treatment success with glyburide. Interprofessional healthcare providers play a crucial role in recognizing the signs and symptoms of hypoglycemia and the frequency of hypoglycemic events while the patient is on glyburide.

Strong clinician judgment is necessary at the first signs of hypoglycemia to determine the appropriateness of continuing therapy. If patients with type 2 diabetes are not at their goal HbA1C or blood glucose target levels, glyburide dosages may be increased every 2 to 4 weeks until meeting the desired objective.[9] After initiating glyburide, starting at a low dosage would be considered the safest precaution to mitigate the risk of hypoglycemia and possible weight gain.

Nursing plays a crucial role in glyburide therapy management by reporting potential hypoglycemia and educating patients about its signs, which should be promptly communicated to the rest of the healthcare team. Simultaneously, the pharmacist, nurse practitioner, and primary care provider should educate the patient about the importance of positive lifestyle modifications, including smoking cessation, adopting a healthy diet, participating in an exercise program, and maintaining healthy body weight, as ample evidence supports the benefits of lower body weight in achieving better diabetes control.[14] [Level 5]

Pharmacists play a critical role in glyburide therapy by verifying appropriate dosing, conducting medication reconciliation, and identifying significant drug-drug interactions, which should be communicated to the rest of the healthcare team for comprehensive patient care.

In summary, the effective use of glyburide therapy for glycemic control in patients with type 2 diabetes necessitates an interprofessional team approach involving physicians, specialists, specialty-trained nurses, and pharmacists. This collaborative effort, characterized by open communication and shared decision-making, is essential to achieve optimal patient outcomes and ensure the success of glyburide treatment. [Level 5]

References

Disclosure: Maiah Hardin declares no relevant financial relationships with ineligible companies.

Disclosure: Tibb Jacobs declares no relevant financial relationships with ineligible companies.

# data[].attributes.attachment_link.description
According to the 2023 update of the American Diabetes Association Standards of Medical Care in Diabetes, glyburide and other sulfonylureas are considered viable options for adjunctive therapy, particularly for patients seeking potent agents with a higher chance of attaining glycemic targets.

# data[].attributes.body
What does it treat? Moderate to severe pain

Drugs within this class: Morphine, heroin, oxycodone, hydrocodone, fentanyl

Mechanism of action: Opioids bind to opioid receptors in the nervous System, which inhibits pain signals between the brain and body.

Indications: Post surgical pain, dental pain, arthritis, acute and chronic pain conditions

Side effects: Dizziness, nausea, vomiting, slowed breathing (bradycardia), constipation, euphoria

Patient considerations: Patients with a past addiction, respiratory instability, psychiatric instability, dependence on other substances, and family history of addiction.

Drug interactions: Benzodiazepines, anti-seizure medications, alcohol, SSRIs (Serotonin syndrome), muscle relaxants, and combining other opioids.

https://www.ncbi.nlm.nih.gov/books/NBK459161/

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids#:~:text=Symptoms%20of%20opioid%20use%20include,risk%20of%20overdose%20and%20death.

# data[].attributes.attachment_link.description
Opioids are a class of medication used in the management and treatment of pain. This activity outlines the indications, actions, and contraindications for opioids as a valuable agent in treating acute and chronic pain. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the management of patients with various forms of pain and related conditions.

# data[].attributes.body
What: They are a class of antibiotics that treat bacterial infections. They can also be an alternative to penicillins if allergic.

MOA: inhibiting enzymes in the cell wall of bacterium.

Ex: Cephalexin, Cefdinir, and Cefuroxime

Dosage forms can be orally or injected in the vein.

Treats: UTIS, meningitis, ear infections, and strep throat.

Side effects: nausea, vomiting, dizziness, and stomach upset.

Drug interactions: warfarin, furosemide, and aminoglycosides.

Patient counseling: They are generally safe for most people, however they should not be taken if a woman is breastfeeding.

https://www.ncbi.nlm.nih.gov/books/NBK551517/

https://www.healthline.com/health/cephalosporins#uses

# data[].attributes.body
Proton Pump Inhibitors

Overview: What is this medication class, and what does it treat?

PPIs are a class of drug called proton pump inhibitors. THey are commonly used to treat GERD and peptic ulcers.

Common Drugs: List a few examples of drugs within this class.

Some examples include  omeprazole, esomeprazole, lansoprazole, dexlansoprazole, and pantoprazole.

Mechanism of Action: How do these medications work in the body?

Proton pumps are an enzyme in the stomach lining that are responsible for creating stomach acid. PPIs work by blocking these enzymes which slows their activity and reduces the production of stomach acid.

Indications: What conditions or diseases are these medications used to treat?

The most common conditions that PPIs treat include GERD and peptic ulcers.

Side Effects: What are the common and severe side effects?

Some possible side effects include diarrhea, constipation, nausea, headache, abdominal pain, gas, c-difficile infection, and increased risk of fractures

Patient Considerations: Are there any important factors or precautions a pharmacist should be aware of when dispensing these medications?

Some things that pharmacists should look out for include C-difficile infections which are a serious diarrheal infection that can be caused by PPIs, increased risk of bone fractures, and deficiencies of magnesium and vitamin B-12.

Drug Interactions: What other medications can interact with these drugs? What should pharmacists monitor?

Some drug interactions include antifungals as PPIs can reduce the absorption of these drugs, iron salts which can have their absorption inhibited by PPIs, and vitamin B-12 supplements which can also have their absorption blocked by PPIs.

Link: https://my.clevelandclinic.org/health/articles/proton-pump-inhibitors

# data[].attributes.body
What does it treat? Viral Injections (COVID, Influenza, Herpes, HIV, and hepatitis)

Drugs within this class: Acyclovir, Oseltamivir, and Sofosbuvir

Mechanism of action: These medications increase the cell’s resistance to the virus and block receptors so the virus can’t bind to healthy cells.

Indications: Patients with viral infections (COVID, ebola, influenza, herpes, HIV, and hepatitis)

Side effects: Cough, dry mouth, fatigue, diarrhea, dizziness, insomnia, N/V, skin rash, and muscle pain

Patient considerations: Patients that are immunocompromised and patients who are inconsistent. Patients need to complete the full course of treatment to not build resistance to these medications.

Drug interactions: Antibiotics (can interfere with the effectiveness), anti platelet drugs (risk of increased bleeding), statins, CV drugs (beta blockers, ACE inhibitors)

https://my.clevelandclinic.org/health/treatments/antivirals

https://www.nfid.org/resource/what-is-an-antiviral/

# data[].attributes.body
Overview: What is this medication class, and what does it treat? Mechanism of Action: How do these medications work in the body?

used to treat inflammatory and autoimmune diseases (i.e. Rheumatoid Arthritis (RA), autoimmune diseases, etc)

suppress immune system to control the inflammation

slows disease progression to save joints and tissues from permanent damage

each DMARD works differently / there are different classes of DMARDs

- conventional : slow-acting and can take several weeks to work

- biological : genetically engineered proteins that target specific parts of the immune system that causes increases in inflammation

-  some are called ANTI-TNF drugs : target a protein called tumour necrosis factor, which increases inflammation when excess amounts are present in the blood or joints

- only given to people who have already tried other treatments & not responded well to them

- often given in combo with a conventional DMARD (i.e. methotrexate)

- only available as an injection or IV

- JAK inhibitor : blocks the action of Janus Kinase enzymes, which are involved in the inflammation symptoms of RA

Common Drugs: Since DMARD is a big class, I will be focusing on biological type of drugs for this section, as they are the newest

Humira (adalimumab)

Enbrel (etanercept)

Remicade (Infliximab)

Stelara (ustekinumab)

Taltz (ixekizumab)

Indications: What conditions or diseases are these medications used to treat?

Rheumatoid Arthritis (RA)

Psoriatic Arthritis (PsA)

Ankylosing Spondylitis (AS)

Systemic Lupus Erythematosus (SLE)

Juvenile Idiopathic Arthritis (JIA)

Sjogren’s Syndrome

Systemic Sclerosis (Scleroderma)

Inflammatory Bowel Disease (IBD) (i.e. Crohn’s Disease, Ulcerative Colitis)

Side Effects: What are the common and severe side effects?

BW: Risk of infections (ALL DMARDS)

(BOTH CONVENTIAL AND BIOLOGICAL)

An increased risk of infections (biologics have a higher risk of this)

Low bc

Low abc

Low platelet count

Traditional DMARD side effects:

Loss of appetite

N/V

Diarrhea

Abdominal pain

Skin rash

Other side effects of biologic DMARDS can include:

Reactivation of chronic (long-term) infections

Elevated cholesterol

Increased risk of blood clots

Infusion or injection site reactions

Patient Considerations: Are there any important factors or precautions a pharmacist should be aware of when dispensing these medications?

Infection Risk

Live vaccines are contraindicated in patients on biologic DMARDs

Liver and Kidney Function (Methotrexate and leflunomide are hepatotoxic)

methotrexate can cause bone marrow suppression, leading to anemia, leukopenia, or thrombocytopenia.

Pregnancy : Methotrexate is teratogenic

Drug Interactions: What other medications can interact with these drugs? What should pharmacists monitor?

Methotrexate + NSAIDs: Increases toxicity risk.

Biologic DMARDs + Other Immunosuppressants: Higher infection risk.

Methotrexate + warfarin: increase risk of bleeing

all DMARDS require close monitoring, blood tests, and xrays

SOURCES:

https://www.ncbi.nlm.nih.gov/books/NBK507863/

https://my.clevelandclinic.org/health/treatments/disease-modifying-antirheumatic-drugs-dmards

https://docs.google.com/presentation/d/1n63fw4kfVSHGRE4nVrx2_V89zCXBqby3ueDeMezb5HQ/edit#slide=id.g3381407d773_0_1499

https://versusarthritis.org/about-arthritis/treatments/drugs/disease-modifying-anti-rheumatic-drugs-dmards/

# data[].attributes.attachment_caption
OVERVIEW: These drugs induce sleep, improve how quickly you fall asleep, and how long you stay asleep.

# data[].attributes.body
Common Drugs: Ambien, Lunesta, and Sonata.

Mechanism Of Action: Suppress the CNS and enhances the activity of GABA to induce sleep and relaxation.

Indications: Insomnia

Side Effects: HA, N/V, daytime drowsiness, dizziness, and difficulties with coordination

Patient Considerations: Serious unsafe sleep behaviors can occur while taking these medications. Sleepwalking, sleep driving, sleep eating/cooking, or unknowingly taking other medications can happen. There are even cases of individuals unknowingly committing suicide while on these medications.

Drug Interactions: Alcohol, benzos, and opiods

LINKS: https://www.rxlist.com/sedativehypnotics/drug-class.htm

# data[].attributes.body
Overview: They are an older class of antidepressants that are now more commonly used in depression that has not responded to other therapies

Common Drugs: Amitriptyline, Nortriptyline, Imipramine, Doxepin

Mechanism of Action: They block the reuptake of serotonin and norepinephrine to increase their availability levels in order to decrease the symptoms of depression

Indications: Major depressive disorder and other depressive disorders are the on-label uses. They are used off-label for anxiety, bedwetting, migraine prevention, insomnia, and chronic pain, including fibromyalgia.

Side Effects: anticholinergic side effects (dry mouth, blurry vision, urinary retention), orthostatic hypotension, tachycardia, weight changes, increased appetite, dizziness. Severe side effects that may indicate overdose include arrhythmia, hypotension, confusion, tremors, seizures, or coma. It may also cause serotonin syndrome.

Patient Considerations: Medications may take 3-4 weeks to work. Special consideration should be taken with patients who have cardiovascular problems or epilepsy, as these problems can be exacerbated. It should also not be taken during pregnancy as it has been correlated with birth defects. Boxed warning- antidepressants can cause suicidal thoughts and behaviors in children and young adults.

Drug Interactions: Some pain, headache, and herbal supplements, as well as other antidepressants, increase the risk of serotonin syndrome.

https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

https://my.clevelandclinic.org/health/treatments/25146-tricyclic-antidepressants

# data[].attributes.body
Antifungals are medications that help the immune system by fighting fungal infections.

Common Drugs: Clotrimazole, Ketoconazole, Fluconazole, Miconazole, Tolnaftate, Nystatin, and Terbinafine.

Indications: Treats fungal infections and diseases.

Mechanism of Action: Kills/stops the fungus from multiplying.

Side Effects: Common side effects are; abdominal pain, upset stomach, diarrhea, itchy skin, and burning sensation or skin rash. Severe side effects are liver damage, severe allergic reactions, and severe allergic skin reactions (blisters and peeling skin).

Drug Interactions: Most of the drugs do not have drug interactions, but floconazole has many. Some of these drugs are warfarin, clopidogrel, amiodarone, atorvastatin, and phenytoin.

Patient Considerations: If breastfeeding infants who develop thrush, their moms will also require treatment due to the potential spread.

Antifungal resistance can develop via skipping doses, stopping treatment too soon, or receiving a too-low dose.

Antifungals additionally take months to complete treatment of the fungal infections, do not stop prematurely and follow the instructions provided.

Sources: https://my.clevelandclinic.org/health/drugs/21715-antifungals

https://my.clevelandclinic.org/health/diseases/10956-thrush

# data[].attributes.body
Antiemetics

Overview: They are medications used to treat nausea and vomiting. These two symptoms are very common and can be caused by many different conditions, therapies, procedures, and medications (such as opioids), and motion sickness.

Common Drugs - Promethazine (Phenergan), Ondansetron (Zofran)

Mechanism of Action - blocks the signals to the brain that causes nausea and vomiting. Promethazine blocks certain histamine receptors in your body, which helps with both allergy related symptoms and affects parts of the brain that control nausea and vomiting. Ondansetron blocks the action of serotonin.

Indications - Nausea and Vomiting, ondansetron was originally prescribed for N/V related to chemotherapy or radiation or to prevent nausea after surgery

Side Effects - Promethazine causes drowsiness, disorientation, confusion, blurred vision, dry mouth, hallucinations or feelings or intense happiness, pleasure, and well being, and changes in blood pressure or heart rate.. Ondansetron causes fatigue, constipation, diarrhea, headaches, weakness, tiredness, and chills.

Patient Considerations - If you are pregnant, you should talk to your OBGYN if N/V during pregnancy is causing distress. Studies show that certain antiemetic drugs are generally safe for use during pregnancy. Promethazine can cause bone marrow suppression, which can lead to infections or bleeding. It can also cause seizures, jaundice, movement problems, and injection of it can cause severe irritation and damage to tissues (which can cause gangrene, tissue death, and other problems). Bowel blockage or gastric distension, bradyarrhythmia, congestive heart failure or heart rhythm problems, hypokalemia, hypomagnesemia, and/or liver disease can affect the use of Ondansetron.

Drug Interactions - Promethazine interacts with barbiturates, opioids, TCA’s, epinephrine, anticholinergic medicine, or any drug that causes drowsiness. Ondansetron should not be taken with apomorphine, bepridil, cisapride, dronedarone, fluconazole, ketoconazole, levoketoconazole, mavorixafor, mesoridazine, pimozide, piperaquine, posaconazole, saquinavir, sparfloxacin, terfenadine, thioridazine, and ziprasidone. Also do not use alcohol or tobacco with it.

# data[].attributes.body
Beta Blockers - Reduces blood pressure

Common Drugs - Metoprolol tartrate/succinate (Lopressor, Toprol XL), Carvedilolo (Coreg), Atenolol (Tenormin), Propranolol (Inderal), Nebivolol (Bystolic)

Mechanism of Action - Beta receptor antagonists that work by blocking the effects of the neurotransmitter epinephrine. They cause the heart to beat more slowly and with less force, which lowers blood pressure.

Indications - High blood pressure (Hypertension, heart failure, angina, arrhythmias, and heart attacks)

Side Effects - Dizziness, fatigue, weight gain

Patient Considerations - Boxed warning is abrupt discontinuation

Drug Interactions - Other drugs that lower BP, alcohol, nasal decongestants, albuterol

https://www.ncbi.nlm.nih.gov/books/NBK532906/

# data[].attributes.attachment_link.readable_text
Continuing Education Activity

Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions. Beta-blockers are indicated and have FDA approval for the treatment of tachycardia, hypertension, myocardial infarction, congestive heart failure, cardiac arrhythmias, coronary artery disease, hyperthyroidism, essential tremor, aortic dissection, portal hypertension, glaucoma, migraine prophylaxis, and other conditions. They are also used to treat less common conditions such as long QT syndrome and hypertrophic obstructive cardiomyopathy. This activity outlines the indications, mechanism of action, safe administration, adverse effects, contraindications, toxicology, and monitoring of the broad array of physiological possibilities when using beta-blockers in the clinical setting.

Objectives:

Summarize the mechanism of action of the beta-blocker class of medications including the difference between selective and non-selective agents.

Identify the indications for beta-blocker therapy.

Review the adverse events, contraindications, toxicities, and interactions of beta-blockers.

Outline the importance of improving care coordination among the interprofessional team to improve outcomes for patients using beta-blockers for indicated conditions.

Access free multiple choice questions on this topic.
Indications

Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions.[1]

Beta receptors exist in three distinct forms: beta-1 (B1), beta-2 (B2), and beta-3 (B3). Beta-1 receptors located primarily in the heart mediate cardiac activity. Beta-2 receptors, with their diverse location in many organ systems, control various aspects of metabolic activity and induce smooth muscle relaxation. Beta-3 receptors induce the breakdown of fat cells and are less clinically relevant at present. Blockade of these receptors by beta-blocking medicines is used to treat a broad range of illnesses.[1] Beta-blockers, as a class of medications, are essential drugs and are first-line treatments in many acute and chronic conditions.

Beta-blockers are indicated and have FDA approval for the treatment of tachycardia, hypertension, myocardial infarction, congestive heart failure, cardiac arrhythmias, coronary artery disease, hyperthyroidism, essential tremor, aortic dissection, portal hypertension, glaucoma, migraine prophylaxis, and other conditions. They are also used to treat less common conditions such as long QT syndrome and hypertrophic obstructive cardiomyopathy. Beta-blockers are available for administration in three main forms: oral, intravenous, and ophthalmic, and the route of administration often depends on the acuity of the illness (parenteral use in arrhythmias), disease type (topical use in glaucoma), and chronicity of the disease.

Congestive heart failure patients are treated with beta-blockers if they are in a compensated state. Specifically, the beta-blockers bisoprolol, carvedilol, and metoprolol succinate are the agents chosen.

Athletes and musicians may use beta-blockers for their anxiolytic effect as well as their inhibitory effects on the sympathetic nervous system. They are not FDA approved for the treatment of anxiety-related disorders; however, they have a potent anxiolytic effect. Combined with a reduction in tremors, they may lead to improved stage performance.

Mechanism of Action

The catecholamines, epinephrine, and norepinephrine bind to B1 receptors and increase cardiac automaticity as well as conduction velocity. B1 receptors also induce renin release, and this leads to an increase in blood pressure. In contrast, binding to B2 receptors causes relaxation of the smooth muscles along with increased metabolic effects such as glycogenolysis.

Beta-blockers vary in their specificity towards different receptors, and accordingly, the effects produced depend on the type of receptor(s) blocked as well as the organ system involved. Some beta-blockers also bind to alpha receptors to some degree, allowing them to induce a different clinical outcome when used in specific settings.

Once beta-blockers bind to the B1 and B2 receptors, they inhibit these effects. Therefore, the chronotropic and inotropic effects on the heart undergo inhibition, and the heart rate slows down as a result. Beta-blockers also decrease blood pressure via several mechanisms, including decreased renin and reduced cardiac output. The negative chronotropic and inotropic effects lead to a decreased oxygen demand; that is how angina improves after beta-blocker usage. These medications also prolong the atrial refractory periods and have a potent antiarrhythmic effect.

Beta-blockers classify as either non-selective and beta-1 selective. There are also beta-2 and beta-3 selective drugs; neither has a known clinical purpose to date. Non-selective agents bind to both beta-1 and beta-2 receptors and induce antagonizing effects via both receptors. Examples include propranolol, carvedilol, sotalol, and labetalol. Beta-1 receptor-selective blockers like atenolol, bisoprolol, metoprolol, and esmolol only bind to the beta-1 receptors; therefore, they are cardio-selective.[2][3][4]

Beta-blockers lower the secretion of melatonin and hence may cause insomnia and sleep changes in some patients.[5]

Alpha-1 receptors induce vasoconstriction and increased cardiac chronotropy; this means agonism at the alpha-1 receptors leads to higher blood pressure and an increased heart rate. In contrast, antagonism at the alpha-1 receptor leads to vasodilation and negative chronotropic, which leads to lower blood pressure and decreases heart rate. Some beta-blockers, such as carvedilol, labetalol, and bucindolol, have additional alpha-1 receptor blockage activity in addition to their non-selective beta receptor blockage. This property is clinically useful because beta-blockers that block the alpha-1 receptor have a more pronounced clinical effect on treating hypertension.[6]

Administration

Beta-blockers are available in oral, intravenous, or ophthalmic forms and are also injectable intramuscularly.

Dosages are available in various ranges, depending on the specific medication.

Adverse Effects

Beta receptors are found all over the body and induce a broad range of physiologic effects. The blockade of these receptors with beta-blocker medications can lead to many adverse effects. Bradycardia and hypotension are two adverse effects that may commonly occur. Fatigue, dizziness, nausea, and constipation are also widely reported. Some patients report sexual dysfunction and erectile dysfunction.

Less commonly, bronchospasm presents in patients on beta-blockers. Asthmatic patients are at a higher risk.[7] Patients with Raynaud syndrome are also at risk of exacerbation. Beta-blockers can induce hyperglycemia and mask the hemodynamic signs, usually seen in a hypoglycemic patient, such as tachycardia.

Some patients report insomnia, sleep changes, and nightmares while using beta-blockers. This effect is more pronounced with beta-blockers that cross the blood-brain barrier.

Carvedilol may increase edema in some patients.[8]

Sotalol blocks the potassium channels in the heart and thereby induces QT prolongation. It increases the risk of torsades de pointes.[9]

All beta-blockers, especially in patients with cardiac risk factors, carry a risk of heart block.

Contraindications

Traditionally, beta-blockers have been contraindicated in asthmatic patients. However, recommendations have aligned for allowing cardio-selective beta-blockers, also known as beta-1 selective, in asthmatics but not non-selective beta-blockers.

Patients who have either acute or chronic bradycardia and/or hypotension have relatively contraindication to beta-blocker usage.

Specific beta-blockers are contraindicated depending on the patient's past medical history. Patients diagnosed with long QT syndrome or who have had torsades de pointes in the past should not use the drug sotalol. Patients with Raynaud phenomenon should avoid beta-blockers due to the risk of exacerbation.[10][9]

Monitoring

The patient's heart rate and blood pressure require monitoring while using beta-blockers. When using sotalol, the clinician must monitor the QTc interval as sotalol has QT-prolonging effects.[11]

Toxicity

The antidote for beta-blocker overdose is glucagon. It is especially useful in beta-blocker-induced cardiotoxicity. The second line of treatment is cardiac pacing if glucagon fails.

Enhancing Healthcare Team Outcomes

Beta-blockers are a broad class of medications that are used for various clinical benefits but also carry the potential for adverse effects. They are prescribed by physicians and nurse practitioners in both outpatient and inpatient settings, largely for the treatment of cardiovascular-related illnesses. While a patient is admitted to an inpatient ward, monitoring the clinical effects and potential adverse effects is an interprofessional task. Nurses will generally be the first caregivers to take note of any unwanted effects, such as a change in vital signs. In contrast, outpatient settings differ in that the pharmacist may be the closest line of healthcare contact for a patient. The pharmacist will dispense the medication, perform medication reconciliation, verify dosing, and also advise other team members and the patient of any potential adverse effects. It is also imperative to take note of any patients who are currently on beta-blockers as it provides a clinical context for potential symptoms. Many clinical trials have been conducted on beta-blockers and shown to prolong life in patients with cardiovascular disease.[12][13][14] [Level 2] The healthcare team needs to prescribe, manage, and monitor the use of beta-blockers safely and effectively. [Level 5]

References

# data[].attributes.attachment_link.description
Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions. Beta-blockers are indicated and have FDA approval for the treatment of tachycardia, hypertension, myocardial infarction, congestive heart failure, cardiac arrhythmias, coronary artery disease, hyperthyroidism, essential tremor, aortic dissection, portal hypertension, glaucoma, migraine prophylaxis, and other conditions.

# data[].attributes.body
1. Overview: What is this medication class, and what does it treat?

Benzodiazepines, used to treat anxiety, stress, insomnia, and epilepsy.

2. Common Drugs: List a few examples of drugs within this class.

Diazepam (Valium)

Oxazepam (Alepam, Murelax)

Nitrazepam (Alodorm, Mogadon)

Temazepam (Euhypnos, Normison)

Alprazolam (Xanax)

Lorazepam (Ativan)

3. Mechanism of Action: How do these medications work in the body?

Benzodiazepines slow down the messages between the brain and the body, enhancing the effect of GABA at the GABA-A receptor, acting as a nervous system depressant.

4. Indications: What conditions or diseases are these medications used to treat?

Benzos are used for insomnia, acute status epilepticus, induction of amnesia, spastic, and seizure disorders.

5. Side Effects: What are the common and severe side effects?

The most common side effects of benzos include: drowsiness, light-headedness, confusion, unsteadiness, dizziness, slurred speech, muscle weakness, and memory problems. More serious side effects include: respiratory arrestor depression, tremors, N/V.

6. Patient Considerations: Are there any important factors or precautions a pharmacist should be aware of when dispensing these medications?

Prescriptions should be limited to 30-day supply, patients should not take if they are already taking opioids - as this could lead to potential overdoses. Pharmacists should be aware that long-term uses can cause tolerance and dependence, short-term use is always encouraged if a patient is on a benzo.

7. Drug Interactions: What other medications can interact with these drugs? What should pharmacists monitor?

Opioids, alcohol, sleep medications (ambien, melatonin, trazodone, eszopiclone, OTC antihistamines) should not be taken with benzos.  Pharmacists should perform a medication reconciliation and report to clinicians for any drug-drug interactions.

https://www.betterhealth.vic.gov.au/health/healthyliving/benzodiazepines

https://pmc.ncbi.nlm.nih.gov/articles/PMC3684331/#:~:text=BZDs%20bind%20to%20the%20pocket%20created%20by%20%CE%B1%20and%20%CE%B3,throughout%20the%20central%20nervous%20system.

https://www.goodrx.com/classes/benzodiazepines/interactions

# data[].attributes.body
H-2 blockers treat stomach ulcers, duodenal ulcers (when stomach acid seeps into the first part of your small intestine causing an ulcer), GERD, and Zollinger-Ellison syndrome (rare- when tumors cause your stomach to release too much stomach acid). They also help relieve indigestion, stomach pain, heartburn, reflux, nausea and vomiting, and upset stomach. After eating the body releases H2 that binds to your stomach cells, which causes your body to secrete stomach acid. H2 antagonists bind to these receptors blocking H2 from binding to the stomach cells reducing stomach acid production. Drugs in this group include: Cimetidine (Tagamet), Famotidine (Pepcid), and Nizatidine (Axid). Side effects include: abdominal pain, muscle pain, constipation, diarrhea, dry mouth, fatigue, and headache. They may also cause (rarely) confusion or slurred speech. They should not be taken with SSRIs, warfarin, or cimetidine. You should consult with a doctor if you are pregnant.

Link: https://my.clevelandclinic.org/health/articles/h2-blockers

# data[].attributes.attachment_link.description
If you experience occasional heartburn and need relief fast, taking an H2 blocker may help. Here’s how they work and when to take them.

# data[].attributes.body
Fluoroquinolones!

Overview-  Class of antibiotics used to treat or prevent certain bacterial infections

FDA advises using fluoroquinolones against 3 common infections: acute sinusitis, acute bronchitis, and UTI without complications as the side effects outweigh the benefits for most people, FDA says okay to use for other serious infections or for patients who have no other choice of treatment

Common Drugs - Ciprofloxacin (Cipro), Levofloxacin (Levaquin), Moxifloxacin (Avelox)

Mechanism of Action - They block DNA replication by inhibiting two enzymes involved in bacterial DNA synthesis. Both of the enzymes are in DNA topoisomerases that human cells lack and are essential for bacteria to replicate.

Indications - Treat bone and joint infections, eye and ear infections, Traveler’s diarrhea, serious respiratory and urinary tract infections, and anthrax

Side Effects - N/V, diarrhea, dizziness, bitter unpleasant taste in the mouth, sun sensitivity, neurological confusion, increase in ruptures or tears in the aorta, significant drops in blood sugar levels, pain, “pins and needles” sensations, depression, anxiety, thoughts of suicide, sensation or nerve damage in hands, feet, arms, or legs

Patient considerations - They can cause ruptured tendons or severe tendonitis with strenuous exercise, increased muscle weakness in patients with myasthenia gravis, cause CNS adverse effects include seizures, increased intracranial pressure, and toxic psychosis, and muscle weakness can be exacerbated in patients with myasthenia gravis. You shouldn’t use them when pregnant either as the drug enters breast milk, and children shouldn’t take them as it is associated with joint malformation. Take these drugs with plenty of water.

DI - They can inhibit clearance of caffeine and theophylline.  Do not use with drugs known to prolong the QT interval or to cause bradycardia (ex. Metoclopramide, cisapride, erythromycin, clarithromycin). Do not take with milk, iron products, antacids, or dairy products as it inactivates the drug.

https://www.webmd.com/cold-and-flu/fluoroquinolones-safety-risks

https://www.sciencedirect.com/science/article/abs/pii/S0039625704000062#:~:text=Fluoroquinolones%20act%20by%20inhibiting%20two,be%20both%20specific%20and%20bactericidal.

https://www.merckmanuals.com/professional/infectious-diseases/bacteria-and-antibacterial-medications/fluoroquinolones

# data[].attributes.body
Overview:

Antipsychotics manage disordered thoughts and personality behaviors such as delusional Disorder, hallucinations, mania, bipolar Disorder, severe agitation or anxiety, major depressive disorder, and schizophrenia (mental and emotional fragmentation and faulty reality perception). Antipsychotic medications can help to calm and clear confusion in a person with acute psychosis within hours or days, but they can take up to four or six weeks to reach their full effect. These medications can help control symptoms but do not cure the underlying condition. When taken over a longer term, antipsychotics can help to prevent further episodes of psychosis.

There are two types: first-generation/ typical antipsychotics and second-generation/atypical antipsychotics

Common Drugs:

Typical

Chlorpromazine (Thorazine)

Thioridazine (Mellaril)

Fluphenazine (Prolixin, Permitil)

Haloperidol (Haldol)

Loxapine (Adusuve)

Atypical

Quetiapine (Seroquel)

Aripirazole (Ablify)

Olanzapine (Zyprexa)

Risperidone (Risperdal)

Lurasidone (Latuda)

Mechanism of action: Antipsychotics change how certain signals in your brain called neurotransmitters affect how you feel and act. If these chemicals are out of balance, you may develop symptoms of psychosis, like hallucinations and delusions. Scientists are still learning exactly how antipsychotics help; however, by changing the balance of the chemicals in your brain, you may start to have fewer symptoms.

Indications: Antipsychotics are mainly used to treat schizophrenia, mania, and bipolar disorder.

Side Effects:

- Abnormal movements

- Constipation

-Dizziness

-Drug-induced movement disorder

-Dry mouth

-High cholesterol

-High prolactin levels

-Jaundice weight gain

-Urinary retention

-dystonias

Pt Considerations:

While there aren’t any main patient considerations pharmacists should watch for when dispensing, they should inform patients that antipsychotics could cause movement disorders and other extrapyramidal symptoms like parkinsonism, akathisia, and dystonia. They should also inform patients that they could develop metabolic effects such as weight gain, hyperglycemia, and hyperlipidemia.

Drug Interactions:

-Aticholinergic

-Antidepressants

-Blood pressure medications

-Heart rhythm drugs

-Mood stabilizers

-Anti-seizure medicines

-Opioid pain relievers

https://my.clevelandclinic.org/health/treatments/24692-antipsychotic-medications

https://www.webmd.com/schizophrenia/schizophrenia-long-lasting-drugs

# data[].attributes.body
Nitrates as a class act as vasodilators. They widen blood vessels to help lessen angina and prevent heart failure.

Common drugs include Nitroglycerin, Isosorbide Mononitrate, and Isosorbide Dinitrate.

Nitrates widen blood vessels, primarily veins, which reduces work load on the heart.

Nitrates are mostly used to treat angina and prevent heart attacks.

Side effects include headache, flushing, dizziness, and burning and tingling under the tongue.

Nitrates may effect other medications being taken by the patient. The patient must also have their blood pressure regularly.

A patient taking a nitrate should not take any drug similar to Viagra, Cialis, or Levitra.

What Are Nitrates? Drug List, Side Effects & Pregnancy Safety

MedicineNet

https://www.medicinenet.com › nitrates-oral › article

https://www.webmd.com/drugs/2/drug-18030/nitroglycerin-oral/details

https://www.ncbi.nlm.nih.gov/books/NBK545149/

# data[].attributes.body
Treat / Indications : bone conditions like osteoporosis and bone metastases

Drugs : Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva), Pamidronate (Aredia), Zoledronic Acid (Reclast)

MOA: slows down bone reabsorption to help strengthen bones

Side Effects : fever, aches, HA, bone joint muscle pain, fractures, stomach ulcers, fractures

Considerations : hypocalcemia, chronic kidney disease, esophageal diseases

Drug Interactions : NSAIDS, antacids, diuretics, antibiotics, PPIs, antivirals

https://my.clevelandclinic.org/health/treatments/24753-bisphosphonates

https://www.ncbi.nlm.nih.gov/books/NBK470248/#:~:text=Avoid%20oral%20bisphosphonates%20in%20patients%20with%20esophageal%20disorders%20such%20as,en%2DY%20gastric%20bypass).

# data[].attributes.attachment_link.description
Bisphosphonates are a class of medications that help treat osteoporosis.

# data[].attributes.body
Overview:

Tetracyclines are a class of antibiotics that treat several kinds of bacterial infections such as acne, chronic bronchitis, lyme disease, pneumonia, chlamydia, anthrax, Rocky Mt. Spotted Fever and oral infections. They work by preventing the growth and spread of bacteria

Common Drugs:

-Minocycline (Minocin)

-Tetracycline (Sumycin)

-Doxycycline (Vibramycin, Doryx, Adoxa)

Mechanism of action:

-Bacteriostatic activity; inhibits protein synthesis

-Tetracycline diffuses through porin channels in the bacterial membrane and reversibly binds to the 30S ribosomal subunit, preventing binding of tRNA to the mRNA-ribosome complex, interfering with protein synthesis.

Indication:

Used to treat bacterial infections such as Rocky Mountain spotted fever, typhus fever, tick fevers, Q fever, rickettsialpox and Brill-Zinsser disease.

Side Effects:

-Stomach upset

-N/V

-Diarrhea

-Sun sensitivity

-Abdominal discomfort

-Decreased appetite

-Rare side effects

-hepatotoxicity

-Kidney failure

-Esophageal strictures

-Intracranial hypertension

Patient Considerations:

Pregnant or nursing patients can't take tetracyclines as they can cause irreversible damage to teeth and bones.

Don’t take with dairy products, antacids, iron or calcium supplements.

Drug Interactions:

-Decreases oral BCP effectiveness

-Abametapir

-Acetylsalicylic acid

https://my.clevelandclinic.org/health/treatments/25214-tetracyclines

https://go.drugbank.com/drugs/DB00759

# data[].attributes.body
Overview: They treat symptoms of allergies. They are broken into first and second generations.

Common Drugs: diphenhydramine, loratadine, fexofenadine, cetirizine

Mechanism of Action: They block the action of histamine in the body

Indications: It’s used to treat allergy symptoms including runny nose, sore throat, watery eyes, rash, and itching, as well as vertigo, nausea, and vomiting.

Side Effects: drowsiness, clumsiness, dizziness, anticholinergic effects, headache, and hoarseness

Patient Considerations: Patients should consult a doctor or pharmacist before taking antihistamines if they have diabetes, BPH, epilepsy, cardiovascular problems, glaucoma, or hyperthyroidism. They should also be aware of overdose symptoms, which include seizures, hallucinations, and severe agitation.

Drug Interactions: Patients may have problems when taking antihistamines with antidepressants, stomach ulcer/indigestion medications, and cough and cold combination medications that already include antihistamines.

https://my.clevelandclinic.org/health/treatments/antihistamines

https://medlineplus.gov/ency/patientinstructions/000549.htm

# data[].attributes.body
Overview: What is this medication class, and what does it treat?

Antiparkinsonian medications are used to manage the symptoms of Parkinson’s disease (neurodegenerative disorder characterized by tremors, rigidity, bradykinesia (slowness of movement), and postural instability)

drugs help restore dopamine levels

Common Drugs: List a few examples of drugs within this class.

Sinemet (Carbidopa-levodopa)

Cogentin (benztropine)

Mirapex (pramipexole)

Requip (ropinirole)

Amantadine – Enhances dopamine release and reduces dyskinesia.

Mechanism of Action: How do these medications work in the body?

Sinemet (Carbidopa-Levodopa):

Levodopa is a precursor to dopamine that crosses the blood-brain barrier and is converted into dopamine by dopamine decarboxylase

Carbidopa inhibits peripheral dopamine decarboxylase, preventing the premature breakdown of Levodopa before it reaches the brain.

Cogentin (Benztropine):

Benztropine is an anticholinergic

controlling tremors and rigidity but does not improve bradykinesia

Mirapex (Pramipexole):

dopamine agonist : binds directly to D2 and D3 dopamine receptors in the brain, mimicking dopamine’s effects.

improve motor symptoms like bradykinesia, rigidity, and tremors

effective in early and late Parkinson’s disease

Requip (Ropinirole):

dopamine agonist

compensates for the loss of dopamine

used for restless legs syndrome (RLS)

Amantadine:

dopamine release and reduces dopamine reuptake in the brain, increasing dopamine availability

Blocks NMDA glutamate receptors: helps reduce excitotoxicity and dyskinesia

mild anticholinergic properties : help with tremors

Indications: What conditions or diseases are these medications used to treat?

PRIMARY IS PARKINSON’S DISEASE

SECONDARY IS RESTLESS LEG SYNDROME

Side Effects: What are the common and severe side effects?

Carbidopa-levodopa: N/V, cardiac arrhythmias, dementia (loss of intellectual function), loss of memory, hallucinations, and orthostatic hypotension

Benztropine: Anticholinergic symptoms, Dry mouth, Blurry vision, Constipation, Trouble urinating, Drowsiness, Confusion

Mirapex (pramipexole) & Requip (ropinirole): Hypotension and dizziness, drowsiness, hallucinations, confusion,  and N/V

Patient Considerations: Are there any important factors or precautions a pharmacist should be aware of when dispensing these medications?

protein competes with Levodopa absorption

abrupt withdrawal can cause severe symptoms

Elderly patients are at higher risk for hallucinations and cognitive impairment.

Drug Interactions: What other medications can interact with these drugs? What should pharmacists monitor?

Carbidopa-levodopa - antipsychotics and anticholinergics : increase confusion/drowsiness

Levodopa : High protein diets

SOURCES:

https://docs.google.com/presentation/d/1pflawRENPV2BxwWgbLrUNyHsT-smUKmBT1Q1xJmhRXQ/edit#slide=id.g32542d93e72_0_2813

https://www.parkinsons.org.uk/information-and-support/parkinsons-drugs

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062#:~:text=Carbidopa%2Dlevodopa%20(Rytary%2C%20Sinemet,the%20brain%20and%20becomes%20dopamine.

https://www.apdaparkinson.org/living-with-parkinsons-disease/treatment-medication/meds-to-avoid/

# data[].attributes.body
Anticonvulsants are medications that help control seizures.

Common Drugs:

Carbamazepine

Phenytoin

Gabapentin

Pregabalin

Topiramate

Divalproex

Levetiracetam

Lamotrigine.

Indications: Anticonvulsants are used to treat epilepsy and seizures. Certain medications may treat anxiety, migraines, bipolar disorder, neuropathic pain, fibromyalgia, restless leg syndrome, and parkinson’s disease.

Mechanism of Action: Antiseizure medications works via controlling the electrical impulses in the brain and inhibits the rapid firing of the neurons. Unfortunately, they do not know how it specifically works.

Side Effects: common side effects are headaches, fatigue, dizziness, blurred vision, nausea, weight gain/loss, and mood changes. Long term usage can lead to osteoporosis.

Some rare side effects are Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, liver failure, pancytopenia, psychosis, and lupus.

Drug Interactions: All medications have different drug interactions.

Carbamazepine have DIs with other anticonvulsants, alcohol, and decreases BCP effectiveness.

Phenytoin has DIs with decreases BCP effectiveness and anticoagulants.

Gabapentin and Pregabalin has DIs with alcohol and enhances CNS depressants.

Topiramate has DIs with other anticonvulsants, CNS depressants, decreases BCP effectiveness, and increased phenytoin levels.

Divalproex has DIs with aspirin, decreased effectiveness of oral BCPs, and alcohol.

Lamotrigine has DIs with other anticonvulsants, acetaminophen, and Oral BCP.

Levetiracetam has DIs with alcohol and other CNS depressants

Patient Considerations: If you take too much of the medication at once, you may reach toxicity from the anticonvulsants.

If taking anticonvulsants, you may be at risk of suicidal thoughts and behavior.

Do not stop abruptly, results in withdrawal seizures.

They must be taken consistently throughout their life.

Source:

https://my.clevelandclinic.org/health/treatments/24781-antiseizure-medications-anticonvulsants

# data[].attributes.body
Common Drugs

Adderall (amphetamine/dextroamphetamine)

Vyvanse (lisdexanfetamine)

SE: Loss of appetite, insomnia, weight loss, HA, N/V, inc. Blood Pressure

Indications

ADHD, Narcolepsy

Patient consideration:

Addiction abuse risk is high

Dosing starts low

BW:

warning for associated CV events

DI: caffeine, avoid highly caffeinated drinks

LINK: https://docs.google.com/presentation/d/1djxjnW84fmm38dr1RTosBj7BvTkrrNrdKyFyQie_OX8/edit#slide=id.g32542d93e72_0_9941