NSAIDS are a class of drugs that treat inflammation, pain, or fever. They are mostly used for a short period of time to treat pain or headaches but can be used to treat chronic pain as well.

Common drugs could include:

(Ibuprofen) - Advil or Motrin, ( Meloxicam) - Mobic, (Celecoxib) - Celebrex, ( Naproxen) - Aleve or Naprosyn, (Diclofenac)- Voltaren, and ( Nabumetone) - Relafen, ( Aspirin) - Bayer.

MOA for NSAIDS: NSAIDS will inhibit enzymes that are responsible for producing inflammatory mediators.

Indications: NSAIDS are often used to treat arthritis, headaches, menstrual pain or any other type of pain relief, treating fevers from a cold or flu, or muscle stiffness.

Side Effects: can include abdominal pain, diarrhea, an upset stomach, darker stool color, hypertension, tinnitus, and dizziness.

Patient Considerations: A pharmacist should be aware if the patient is pregnant, if they are on blood thinners, if they have a history of stomach ulcers, kidney and liver problems, or if the patient is allergic to aspirin.

Drug Interactions: Drug Interactions can include Aspirin, taking NSAIDs together, beta blockers, digoxin, warfarin, diuretics, and oral hypoglycemics.

Link: https://my.clevelandclinic.org/health/treatments/11086-non-steroidal-anti-inflammatory-medicines-nsaids

Common Antifungals: Tolnaftate (Tinactin), Nystatin (Mycostatin), Terbinafine (Lamisil), Ketoconazole (Nizoral), Clotrimazole (Lotrimin), Miconazole (Monistat), Fluconazole (Diflucan)

Mechanism of Action: Antifungals are used to kill, destroy, attack and damage, and to stop fungi from multiplying and/or growing.

Indications: Athlete's foot, jock itch, ringworm, dandruff, fingernail infection, toenail fungus, yeast infections

Side Effects: Nausea and vomiting, abdominal pain, diarrhea, burning and itching of the skin, rash, liver damage, anaphylaxis

Patient Considerations: Those with liver and heart problems shouldn't take antifungal medications due to their potential to cause liver and heart problems.

Drug Interactions: There are several drug interactions for antifungal including:

Warfarin: When combined with an antifungal, it will cause an increased anticoagulant effect

Clopidogrel: When combined with antifungals, it will become inactivated

Amiodarone: When combined with antifungals, it will cause an increased arrhythmia risk

Atorvastatin and Phenytoin: When combined with antifungals, they will result in elevated levels

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

Antiviral medications help to fight off viruses that infect the body and cause harm by reducing symptoms and reducing the length of infection. They may also be preventative against certain viruses, meaning that they prevent the transmission of the illness to new people.

Common Drugs:

Zovirax (acyclovir)

Valcyte (valacyclovir)

Sovaldi (sofosbuvir)

Paxlovid (nirmatrelvir / ritonavir)

Tamiflu (oseltamivir)

Valcyte (valganciclovir)

Mechanism of Action:

There are various mechanisms of actions that antivirals may have, though they all have the same purpose to help the body fight off viral infections. Some mechanisms of action include blocking receptors in the body to prevent viruses from binding to healthy cells or boosting the body's immune system to help fight off infection more easily. Unlike antibiotics, antivirals do not directly kill viruses in the body. Instead, they inhibit viral growth and enhance the body's ability to fight them.

Indications:

Some major indications include COVID-19, ebola, influenza, herpes, hepatitis B and C, HIV, and Mpox.

Side Effects:

Common side effects include cough, dry mouth, diarrhea, dizziness, fatigue, headaches, insomnia, joint pain, muscle pain, nausea and vomiting, skin rash, and abdominal pain

Patient Considerations:

Zovirax and Valtrex should be used with caution in patients with liver and kidney impairments, as well as in older adults. Tamiflu should also be used with caution in patients with renal impairment and should be taken with food. Paxlovid must be used only in patients at least 12 years of age and weighing at least 88 pounds and should be used with caution in patients with liver and kidney impairments.

Drug Interactions:

One major drug interactions for antiviral medications are live vaccines such as influenza, varicella, and herpes zoster because the antiviral medications reduce the effectiveness of such vaccines. Paxlovid has various drug interactions, with its main one being statins.

Links:

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

Common Drugs:

-Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone)

Mechanism of Action:

-Bind to regulatory binding sites of GABA (GABA-A)

and affect its receptors. It enhances the neurotransmitter GABA's effects, increasing sedative effects and slowing down activity in the brain to induce sleep.

Indications:

-FDA-Approved: for those with insomnia, lacking good sleep quality, and those who have difficulty falling asleep.

-Off-Label: restoring brain function in vegetative patients after brain surgery

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

-Common: bitter/metallic taste in the mouth, dry mouth, drowsiness, HA, dizziness, N/V, diarrhea, and back pain

-Severe: memory loss (amnesia), hallucinations, prone to falling, depression

Patient Considerations:

-Complex sleep behaviors can occur such as sleep walking, sleep-driving, sleep-eating, and accidentally overdosing

-Meant for short-term use

-Increased risk of motor vehicle accidents

-Risk for addiction or dependence

-Only take before bedtime

Drug Interactions:

-Opioids, benzos, antidepressants (Ex. TCAs and SSRIs), alcohol, some antimicrobials, some seizure meds, muscle relaxers, and Benadryl

Sources:

https://www.sciencedirect.com/topics/neuroscience/z-drug

https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks

https://evokewellness.com/blog/z-drug-mechanism-action-inducing-sleep/#:~:text=Z-Drugs%20Mechanism%20of%20Action,on%20a%20short-term%20basis.

https://www.ncbi.nlm.nih.gov/books/NBK442008/#:~:text=Zolpidem%20is%20a%20non-benzodiazepine,from%20zolpidem%20therapy%20for%20insomnia.

https://www.nhs.uk/medicines/zolpidem/side-effects-of-zolpidem/

https://www.thecarlatreport.com/articles/3193-the-z-drugs-safety-issues-and-misuse-potential

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

Sources: https://vestib.com/antiemetic-drugs.html

https://www.ncbi.nlm.nih.gov/books/NBK532303/#:~:text=These%20include%20ondansetron%2C%20granisetron%2C%20dolasetron,are%20the%20most%20frequently%20encountered.

https://www.healthline.com/health/antiemetic-drugs-list

Overview: By effecting the hormone epinephrine, also known as adrenaline, beta blockers lower blood pressure.

Common Drugs: Tenormin (atenolol), Lopressor/Toprol XL (metoprolol), Bystolic (nebivolol), Inderal (propranolol)

Mechanism of Action: Beta blockers cause the heart to beat with less force and at a slower pace. They also widen veins and arteries in order to improve blood flow.

Indications: Arrhythmias, heart failure, angina, heart attacks, and tremors.

Side Effects: Cold hands/feet, tiredness, weight gain.

Patient Considerations: The medicine may trigger severe asthma attacks.

Drug Interactions: Calcium Channel Blockers, Diuretics, ACE Inhibitors

Links:

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522

Common Drugs: Thorazine (chlorpromazine), Mellaril (thoridazine), Abilify (aripiprazole), Clozaril (clozapine), Caplyta (lumateperone), Risperdal (risperidone), Zyprexa (olanzapine) and Seroquel (Quetiapine)

MOA:

• First Generation Antipsychotics: First-generation antipsychotics typically work by inhibiting dopamine neurotransmission specifcially the D2 dopamine receptors in the brain.

• Second Generation Antipsychotics: Second-generation antipsychotics work also by blocking the D2 dopamine receptors as well as serotonin receptors in the brain.

Indications:

• Schizophrenia

• Acute mania

• Major depressive disorder with psychotics features

• Delusional disorder (first-generation)

• Severe agitation

• Tourette Syndrome (off-label)

• Borderline Personality Disorder w/ psychosis and paranoia

• Dementia and Delirium (low dose first-gen and off-label second gen)

• Substance-induced psychotic disorder

• Childhood Schizophrenia

Side Effects:

• Constipation

• Yellowing skin and eyes

• Dry mouth

• Dizziness

• Weight Gain

• Trouble staying awake

• Uncontrolled jerking movements (ie tremors)

• Heart and circulatory problems

• Trouble urinating

• Painful muscle contractions

Patient Considerations:

• Patients should be advised not to drink alcohol while on these medications as it can affect the effectiveness of the drug and in some cases it can be very dangerous.

• If taking Seroquel your doctor should advise that you do not drink grapefruit juice or eat grapefruit as it can affect the levels of the drug in the body.

Drug Interactions:

• Anticholinergic drugs - can worsen the anticholinergic SE of the drugs

• Antidepressants

• Antihistamines - increase drowsiness

• Benzodiazepines - increase drowsiness

• Blood Pressure - can cause abnormal heart beat or blood pressure

• Anticonvulsants

Sources:

• Cleveland Clinic

• NIH

• Rethink Mental Illness

• WebMD

Drugs lisinopril (Prinivil, Zestril) benazepril (Lotensin) enalapril (Epaned, Vasotec) ramipril (Altace)

Mechanism of action: ACE inhibitors inhibit the enzyme ACE, a key enzyme in the angiotensin cycle. Without ACE, angiotensin I can't turn into angiotensin II, which decreases the amount of angiotensin II in the body. Since angiotensin II is a vasoconstrictor (constricts the blood vessel), the blood pressure in the body is lowered as the blood can flow through the blood vessels more easily. ACE enzyme also stimulates the production of aldosterone, which is a hormone that makes the body retain sodium and increases blood pressure. Since the ACE enzymes are not present, less aldosterone is made, which also helps reduce blood pressure. 

Indication: ACE inhibitors treat high blood pressure (hypertension), heart failure, Coronary artery disease, diabetes, and even some types of chronic kidney disease.

Side effects: drug-induced dry cough, hypotension, angioedema, dizziness, increased  potassium levels, diarrhea, and joint pain

Patient considerations: A pharmacist should know about the boxed warning for fetal toxicity to make sure no one who is getting this medication is pregnant. The pharmacist should also warn patients about swelling under the skin, as it could be a life-threatening allergic reaction. A pharmacist should tell patients not to get pregnant and if they see swelling, to stop taking the medication and go to the ER immediately. 

Drug interactions: other medications that lower BP, potassium-sparing diuretics, NSAIDs, lithium, medications that affect sodium levels, medications that affect your kidneys, and potassium supplements

Link: https://my.clevelandclinic.org/health/treatments/21934-ace-inhibitors

Bisphosphonates are a class of medications that help to increase bone density and strength. They are able to be given both orally and intravenously.

Common Drugs:

Actonel (risedronate)

Fosamax (alendronate)

Boniva (ibandronate)

Reclast (zoledronic acid)

Mechanisms of Actions:

Bisphosphonates work by slowing down bone resorption in order to increase the calcium density in bones. This allows the body to form bone at an equal rate to bone resorption.

Indications:

These drugs are mainly used to treat or prevent osteoporosis, both in men and postmenopausal women. However, other conditions, such as bone cancer and hypercalcemia can be treated. This is because these medications help improve bone strength and reduce the amount of calcium released into the blood.

Side Effects:

Common side effects include headache, upset stomach, esophageal irritation, nausea, diarrhea, heartburn, gastritis, ulcers, fever, aches, and general pain.

Patient Considerations:

Be sure to take biphosphonates at least thirty minutes before eating your first meal of the day and with 6-8 ounces of water. After taking, make sure to remain upright. Doing this allows for efficient absorption of the drug while also preventing gastrointestinal irritation.

Drug Interactions:

Calcium supplements and antacids both interact with biphosphonates, as they decrease absorption of the drug.

Links:

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

• Namenda (Memantine)

  - Alzheimer's & Dementia

  - Blocks the effects of glutamate on the brain and its functions. (memory)

  - SE: N/V, insomnia, mood change, dizziness, HA's, drowsiness, constipation

  - Tolerated the best out of all 3

  - Interactions include cimetidine, nicotine, ranitidine, quinidine, sodium bicarbonate, antiviral, dextromethorphan, diuretics, glaucoma, and metformin. (https://www.rxlist.com/namenda-drug.htm)

• Exelon (Rivastigmine)

  - Dementia, Parkinson's, and Alzheimer's

  - (not exactly known) according to accessdata.fda.gov it's probably increasing the concentration of acetylcholine through reversible inhibition of its hydrolysis by cholinesterase.

  - SE: N/V, agitation, rash, loss of appetite, weight loss, confusion, mood change, insomnia, and diarrhea.

  - Patch is specifically for Alzheimer's patients

  - Interactions include atropine, helladonna, clidinium, dicyclomine, glycopyrrolate, hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, scopolamine. (same place)

• Aricept (Donepezil)

  - Alzheimer's

  - Inhibits acetylcholine hydrolysis

  - SE: N/V, agitation, loss of appetite, weight loss, rash, confusion, diarrhea, mood change.

  - Do not use with cardiac disease, liver problems, or parkinson's disease.

  - Interactions include NSAIDS, Nicotine, and theophylline.

• Thiazide diuretics (Thiazides are the most commonly prescribed diuretics. They’re most often used to treat high blood pressure. These drugs decrease fluids and cause your blood vessels to relax.)

  • Microzide (hydrochlorothiazide)

• Loop diuretics (Loop diuretics are often used to treat heart failure)

  • Lasix (furosemide)

• Potassium-sparing diuretics (Potassium-sparing diuretics reduce fluid levels in your body without causing you to lose potassium)

  • Dyrenium (triamterene)

• Combination

  • Maxzide (triamterene & hydrochlorothiazide)

MOA

• Water pills make your kidneys take away your body’s extra salt and water by putting them into your urine (pee). By clearing out extra fluids from your body, diuretics lower the amount of fluid in your blood that your heart has to pump. This helps people whose kidneys aren’t working well or who have swelling (edema), heart failure or high blood pressure.

Indications

• High BP

• HTN

• Pulmonary edema (fluid buildup in your lungs)

• Kidney failure

• Buildup of fluid almost anywhere in your body (stomach, eyes, brain, etc.)

SE

• Upset stomach, gas or diarrhea

• Loss of appetite

• Hair loss

• Fatigue

• HA

• Gout

• Erectile disfunction

• Low potassium (for some types)

• Muscle cramps

• Higher blood sugar in people with diabetes

• Unbalanced electrolytes

Patient Considerations

• It may negatively affect patients who are pregnant, breastfeeding, have kidney or liver issues, or diabetes

Drug Interactions

• antidepressants such as fluoxetine (Prozac) and venlafaxine (Effexor XR)

• lithium

• digoxin (Digox)

• other drugs for high blood pressure

Cites

https://www.healthline.com/health/diuretics#use

https://my.clevelandclinic.org/health/treatments/21826-diuretics

SSRIs are a class of medications that treat depression and many other mental health conditions.

Common Drugs:

(Paroxetine) - Paxil, ( Fluoxetine) - Zoloft, ( Sertraline)- Prozac or Sarafem, ( Citalopram) - Celexa, ( Escitalopram ) - Lexapro.

Mechanism of Action: SSRIs blocks reabsorption of serotonin so more is available in the brain

Indications: Often used in cognitive therapy and can also treat conditions like generalized anxiety, PTSD, OCD, premenstrual syndrome, and fibromyalgia.

Side Effects: can include nausea and vomiting, diarrhea, anxiety, headaches, nervousness, weight loss, and a decreased libido/ sexual dysfunctioning.

Patient Considerations: This classification should not be taken or has warnings with conditions like pregnancy, bipolar disorder, hemophilia, diabetes, epilepsy, glaucoma, or heart, liver, or kidney problems. It can also increase a person's risk with having suicidal thoughts and behaviors and could cause withdrawal symptoms if stopped abruptly. Serotonin Syndrome is also something that could occur if a person is talking drugs that could also increase their serotonin levels.

Drug Interactions: include alcohol and benzodiazepines because they both increase sedation, warfarin because they increase anticoagulant effects, antiepileptics because they decrease seizure threshold, and serotonin syndrome.

Link: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825#:~:text=How%20SSRIs%20work,depression%2C%20such%20as%20anxiety%20disorders.

Common Drugs: 

1. Almotriptan(Axert)

2. Eletriptan(Relpax)

3. Frovatriptan(Frova)

4. Naratriptan(Amerge)

5. Rizatriptan(Maxalt)

6. Sumatriptan(Imitrex, Onzetra, Tosyma)

7. Zolmitriptan(Zomig)

MOA: Triptans bind to neurogenic and central 5 serotonin receptors, causing an inhibition of the release of vasoactive neuropeptides via inhibition of the trigeminal nerve activation, this blocks the transmission of pain signals to the brain and thus the Migraines.

Indication: Used to treat Migraine or cluster headaches

Common Side effects:

1. Dizziness

2. Drowsiness/Fatigue

3. Flushing 

4. Nausea

5. Neck Pain

6. Sweating

7. Paresthesia

8. Chest Pain(rare)

Caution for those with: 

1. Cardiovascular risk

2. Those who are pregnant or breastfeeding

Drug Interactions:

1. Medications containing ergotamine(used to constrict arteries thus doubling the effect to a dangerous amount)

2. If on SSRI’s you should be aware of Serotonin syndrome(Antidepressants) 

Sources(All By Luca De Filippo): https://americanmigrainefoundation.org/resource-library/migraine-drug-interactions-faq/, https://www.ncbi.nlm.nih.gov/books/NBK554507/, https://my.clevelandclinic.org/health/treatments/24998-triptans

Common Penicillins: Penicillin (Pen VK), Amoxicillin (Amoxil), Ampicillin (Omnipen), Amoxicillin/Clavulanate Potassium (Augmentin)

Mechanism of Action: Penicillins work by attaching to and damaging the cell walls of bacteria, eventually destroying the bacteria completely.

Indications: Strep throat, otitis media, STDs (Syphillis and Gonorrhea), endocarditis, pneumonia, skin infections, staph infections, salmonella, meningitis, lyme disease, tooth infections, urinary tract infections

Side Effects: Nausea, vomiting, diarrhea, skin rash, changes in taste or smell, headache, stomach upset, anaphylaxis,

Patient Considerations: Penicillin allergies are very common, so before dispensing any drug within this class, prescribers need to make note of the patient's allergies, to ensure they aren't allergic to penicillin, as it can result in serious damage to the body systems and even death.

Drug Interactions:

Oral Birth Control: Penicillins can reduce the efficacy

Anti-inflammatories, Aspirin, and Probenecid: They will compete with the Penicillins for elimination and will result in penicillin toxicity

Links: https://my.clevelandclinic.org/health/treatments/penicillin

https://dermnetnz.org/topics/penicillin#:~:text=Drug%20interactions%20are%20uncommon.,antibiotics%20occasionally%20reduce%20their%20effectiveness

https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

Macrolides are a class of drugs used to manage and treat various bacterial infections.

Common Macrolides:

Azithromycin (zithromycin), clarithromycin(Biaxin), and erythromycin are commonly used to treat infections like pneumonia, sinusitis, pharyngitis, and tonsillitis.

Mechanism of Action:

Macrolides inhibit bacterial protein synthesis. The MOA is revolved around their ability to bind the bacterial 50S ribosomal subunit causing the cessation of bacterial protein synthesis. Once it binds, the drug prevents the translation of mRNA, specifically the growing peptide chain, by preventing the enzyme peptidyltransferase from adding the subsequent amino acid attached to the tRNA.

Indications:

Pneumonia, sinusitis, pharyngitis, and tonsillitis.

Side Effects:

Steven johns syndrome, nausea, diahrrhea, abdominal pain.

Drug interactions:

Make sure to avoid alcohol, statins, antifungals, warfarin.

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK551495/#:~:text=Macrolides%20are%20a%20class%20of,sinusitis%2C%20pharyngitis%2C%20and%20tonsillitis.

https://www.sciencedirect.com/science/article/abs/pii/S0022283603006624

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

• Overview:Antibiotic for bacterial infections 

• Common Drugs: ciprofloxacin (Cipro), moxifloxacin (Avalox)

• MoA: Inhibits DNA synthesis by targeting two essential type II topoisomerases

• Indications: bacterial bronchitis, pneumonia, sinusitis, urinary tract infections, septicemia and intraabdominal infections, joint and bone infections, soft tissue and skin infections, typhoid fever, anthrax, bacterial gastroenteritis

• Side Effects/Adverse Events: peripheral neuropathy, retinal detachment, QTc prolongation and cardiac arrhythmia, N/V, diarrhea, taste disturbance, hepatotoxicity

• Patient Considerations: Fluoroquinolones can weaken the collagen matrix in tendons, making tendons weaker and increasing the risk of rupture (Pharmacy Times)

• Drug Interactions: antacids, sucralfate, calcium, iron, theophylline, caffeine, warfarin

MOA: They help to relax your veins and arteries to decrease your blood pressure by reducing the action of angiotensin II.

Drug interactions: Other drugs that are used to lower blood pressure and potassium supplements.

Common ARBs :

Avapro (irbesartan)

Cozaar (losartan)

Benicar (olmesartan)

Diovan (valsartan)

Side Effects: dizziness, HA, fatigue

Box Warning: Fetal toxicity

+ DO NOT USE WITH ACE INHIBITORS

+ PLEASE DO NOT USE WHILE PREGNANT OR TRYING TO GET PREGNANT. IT IS NOT ADVISED.

Sources: my notebook and that one brain cell that's been working overtime since 07:20.

Common Drugs:

Sulfonylureas: Glucotrol (glipizide), Amaryl (glimepiride), Diabeta (glyburide)

DPP-4's: Onglyza (saxagliptin), Januvia (sitagliptin)

Biguanides: Metformin (glucophage)

Thiazolidinediones: Actos (pioglitazone)

SGLT-2's: Invokana (canagliflozin), Farxiga (dapagliflozin)

Mechanism of Action:

Sulfonylureas: Trigger the release of insulin from the pancreas

DPP-4's: Cause the release of insulin when blood sugar is rising

Biguanides: Limit the liver's ability to release sugar

Thiazolidinediones: Improve cells' sensitivity to insulin

SGLT-2's: Limit the kidney's ability to take in sugar, which increases the sugar excreted in urine

Indications: if blood sugar levels cannot be regulated in any other way

Side Effects: hypoglycemia, weight gain, skin rash, nausea/vomiting

Patient Considerations: There is a low risk factor when taking sulfonylureas if allergic to sulfa drugs.

Drug Interactions: Ace inhibitors, beta blockers, anticholinergics, NSAIDs

Link:

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

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

• Methotrexate (Rheumatrex)

• Azulfidine(Sulfasalazine)

• Hydroxychloroquine (Plaquenil)

  
  

Mechanism of Action:

• Methotrexate works by decreasing inflammation in the body and this reduces pain and prevents long-term injury to the joints and skin.

• Azulfidine is used to treat and prevent mild- moderate acute attacks. It works inside the bowels by helping to reduce the inflammation and other symptoms of the disease. 

• Hydroxychloroquine works by killing the parasite that causes malaria in the patient's body. It also slows down your overactive immune system. 

  
  

Indications:

Methotrexate: treats inflammatory conditions such as arthritis.

Azulfidine: Are to treat adults and children with rheumatoid arthritis in patients who cannot tolerate other medicines like NSAIDs for rheumatoid arthritis.

Hydroxychloroquine: may work to treat rheumatoid arthritis and systemic lupus erythematosus by decreasing the activity of the immune system.

Side Effects: 

• Methotrexate side effects are N/V, allergic reactions, dry cough, shortness of breath or trouble breathing, infection, blistering, seizures, diarrhea, dizziness, pain, and hair loss.

• Azulfidine side effects are dark yellow or orange urine, rash, fever, dizziness, HA, loss of appetite, N/V, and upset stomach.

• Hydroxychloroquine side effects are HA, N/V, diarrhea, thoughts of suicide or feelings of depression, hypoglycemia, and Change in vision.

  
  

Patient Considerations: DMARDS should be avoided with patients who have active infection, preexisting bone marrow hypoplasia, leukopenia, women who are pregnant, or immunodeficiency syndromes. 

Drug Interactions: Several medications such as NSAIDs, PPI’s, sulfasalazine, and amoxicillin can increase its efficacy and increase the risk of adverse effects. Before starting on a DMARD, patients need to be screened for hepatitis B & C. For women they must take a pregnancy test before taking any DMARDs. Monitoring patients is recommended and should be continued as long as the patient is on a DMARD.

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

https://www.mayoclinic.org/drugs-supplements/sulfasalazine-oral-route/description/drg-20066179

https://www.ncbi.nlm.nih.gov/books/NBK507863/#:~:text=DMARDs%2C%20especially%20biologic%20DMARDs%2C%20shall,patients%20with%20severe%20liver%20disease.

Common Drugs:

-Norvasc (amlodipine), Cardizem (diltiazem), Procardia (nifedipine), Verelan (verapamil), and Sular (nisoldipine)

Mechanism of Action:

-They block the calcium channels from entering the cell by binding to the L-type "long acting" type of channels in the heart, vascular smooth muscle, and pancreas. With less calcium in the heart and arteries, blood pressure can go down and the muscles can relax.

Indications:

-FDA-Approved: hypertension, arrhythmias, angina, coronary artery spasm, enlarged heart, pulmonary hypertension, and subarachnoid hemorrhage

-Off-Label: Raynaud's phenomenon, prevention of migranies, anal fissures, and altitude sickness

Side Effects:

-Common: constipation, dizziness, fast heartbeat, fatigue, flushing, HA, N, swelling in feet and ankles

-Severe: gingival hyperplasia, increased symptoms for GERD and heartburn, and symptoms of a heart attack

Patient Considerations:

-Monitoring tests are required: liver function, bp monitoring, heart rate assessment, and ECG monitoring

-A better alternative to other blood pressure-lowering medications

-Can be used in combination therapy

-Take the prescribed dose on time and don't attempt to "catch up" for a dose (can lead to adverse reactions or death).

-Notify doctor if: SOB, chest pain, fainting, and swelling in the face or arms

Drug Interactions:

-Grapefruit juice, other BP lowering drugs (ex. verapamil)

Sources:

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/calcium-channel-blockers/art-20047605

https://www.ncbi.nlm.nih.gov/books/NBK482473/

https://www.rxlist.com/calcium_channel_blockers_ccbs/drug-class.htm

https://my.clevelandclinic.org/health/treatments/22316-calcium-channel-blockers

• Overview: Antidiabetic for diabetes, mostly I but can also treat II

• Common Drugs: insulin lispro (Humalog) - Cleveland Clinic, insulin isophane (Hunulin N) - Healthline, insulin glargine (Lantus) - NHS

• Mechanism of Action for Long-Acting Insulin: Provides the body with artificial insulin and binds to insulin receptors 

• Indications: Type I and II Diabetes

• Side Effects: Skin localized lipodystrophy, allergic reactions, developing insulin antibodies - Cleveland Clinic

• Patient Considerations: Rotate injection sites and only inject into the fat under the skin

Common Drugs: Tegretol (carbamazepine), Klonopin (clonazepam), Neurontin (gabapentin), Keppra (levetiracetam), Dilantin (phenytoin), Lyrica (pregabalin), Topamax (topiramate)

MOA: Anticonvulsants work by decreasing neuron excitability which helps to prevent seizures. They usually do this in a few different ways. One way that they decrease neuron excitability is by inhibiting the neurotransmission of GABA. Additionally, they may act on the ion channels of neurons to reduce electrical signals.

Indications: Some indications may be off label for the medications

• Seizures

• Epilepsy

• Anxiety

• Migraine headaches

• Neuropathic pain

• Restless leg syndrome

• Parkinson's disease

Side Effects:

• Headache

• Fatigue

• Dizziness

• Blurred vision

• Nausea

• Weight gain or loss

• Mood changes

Patient Considerations:

• Patients should be advised to take their medications as directed and be warned that it may take a few weeks to obtain desired effect

• Patients should be warned not to drink alcohol or take other CNS depressants while on these medications.

  
  

Drug Interactions:

• Oral contraceptives - may decrease concentration of some anticonvulsants

• Antibiotics

• Antidepressants

• Antineoplastic drugs

• Antipsychotics

• Immunosuppressants

• Oral anticoagulants

Sources:

• Cleveland Clinic

• WisTech Open

• NIH

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Drug: Amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), and imipramine (Tofranil)

Mechanism of action: TCAs work by stopping the reuptake of norepinephrine and serotonin in the brain, specifically in the synaptic cleft. This increases the amount of norepinephrine and serotonin in the brain. This helps alleviate feelings of depression. They also block histamine, alpha-adrenergic, and muscarinic receptors, which are the parts of the brain that trigger the sedative, hypotensive, and anticholinergic side effects of antidepressants (dry mouth, drowsiness, and dizziness).  

Indications: Depression, they enhance the effect of pain medications, PTSD, migraines prevention, OCD, major depressive disorder, nocturnal enuresis, and dysthymia

Side effects: Blurred vision, urinary retention, dry mouth, constipation, and seizures

Patient considerations: The pharmacist should let the patient know it might take 2-4 weeks in order to notice a difference in mood. They should also tell the patient to avoid alcohol and be careful when operating machinery. Finally, tell the patient to store the medication away from any children or animals, as they could overdose on them. 

Drug interactions: other medications that increase the level of serotonin (as they could lead to serotonin syndrome), monoamine oxidase inhibitors, beta blockers, calcium channel blockers, CNS depressants, and alcohol

https://www.ncbi.nlm.nih.gov/books/NBK557791/ 

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

Statins are prescription drugs people take to lower their level of LDL or “bad” cholesterol that builds up in arteries. They belong in the cardiovascular class.

Drugs

• Atorvastatin (Lipitor)

• Lovastatin (Mevacor)

• Pravastatin (Pravachol)

• Rosuvastatin (Crestor)

• Simvastatin (Zocor).

MOA

• Statins get in the way when your liver is trying to make cholesterol by not letting the liver have an enzyme (HMG CoA reductase) that it needs to create cholesterol. This is also why statins are called HMG CoA reductase inhibitors.

Indications

• People who have high cholesterol (LDL above 190 mg/dL) and can’t reduce it by changing their eating and physical activity habits.

• People who have an LDL above 160 mg/dL, a family history of early coronary artery disease and are 20 to 39 years old.

• People who have a history of a stroke, heart attack or peripheral artery disease (PAD).

• People who have diabetes and an LDL of at least 70 mg/dL and are 40 to 75 years old.

• People who have an LDL of at least 70 mg/dL and a high risk of getting heart disease and are 40 to 75 years old.

• People who have heart failure

• People who have a heart or blood vessel disease

SE

• HA

• Nausea

• Dizziness

• Gas

• Diarrhea

• Constipation

• Achy muscles or joints

• Confusion

• Memory loss

• Damage to your kidneys

• Damage to your liver

• High blood sugar

Patient Considerations

• Warn patients about eating grapefruit and pomegranate

• You should avoid statins if you’re pregnant, nursing or have certain types of liver disease.

DI

• Fibrates: Statins and fibrates each have a risk of muscle pain and serious muscle damage that leads to rhabdomyolysis.

• HIV meds: HIV medications have many potential drug interactions. This is because they can affect how other medications are broken down in the body, including statins

• Warfarin: When taken with warfarin, certain statins may increase the risk of bleeding.

Cites

https://my.clevelandclinic.org/health/treatments/22282-statins

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

Nitrates drugs are mainly used for the management and treatment of angina.

Common Drugs

1. Nitroglycerin (Nitrostat)– angina pectoris, acute coronary syndrome, heart failure, and hypertension

• Sublingual tablet – 0.3 to 0.6 mg, up to 1.5 mg as needed a day

• Transdermal patch – 0.2 – 0.8 mg/h, one patch a day (remove at night for 12h)

• Ointment – 7.5 – 40 mg a day

• Spray – 0.4 to 0.8 mg, 1 to 3 times a day; max 3 actuations in 15 minutes

  
  

2. Isosorbide mononitrate (Ismo or Imdur) – chronic angina pectoris

• Tablet – 10 to 40 mg 3 times a day

• Sublingual tablet – 2.5 to 10 mg

• Spray – 1.25 mg per dose

  
  

3. Isosorbide dinitrate (Isordil) – angina pectoris

• Tablet – 20 mg twice daily, 7 hours apart

• Tablet (Sustained release) – 30 to 120 daily; max daily dose 240 mg daily

Mechanism of Action

Nitrates dilate the blood vessels in the heart, increase oxygen and blood flow to relieve chest pain, and reduce the workload on the heart.

Indications

Angina pectoris, acute coronary syndrome, arterial hypertension, and heart failure.

Side Effects

• Headaches

• Hypotension

• Cutaneous flushing

• Syncope

• Reflex tachycardia

• Methemoglobinemia (rare) - nitrate toxicity

Contraindications

• Allergy to nitrates

• Right ventricular infarction

• Hypertrophic cardiomyopathy

Patient Considerations

Conditions that require care while using nitrates:

• Patients on diuretic therapy - Volume depleted and hypotension

• Patients who have low systolic blood pressure - Severe hypotension.

• Elderly patients and patients with autonomic nervous system dysregulation - High risk of orthostatic hypotension

• Pregancy - nitrates should be avoided (Nitrates have not been evaluated fully in pregnancy and breastfeeding)

Drug Interactions

• Tadalafil and sildenafil - PDE inhibitors and nitrates cause vasodilation. If used together, it may cause severe hypotension

Links:

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

Common Drugs: 

1. dextroamphetamine mixed salts and amphetamine(Adderall)

2. dexmethylphenidate hydrochloride(Focalin)

3. methamphetamine hydrochloride(Desoxyn)

MOA: Increases catecholamine levels and increased agonistic activity at adrenergic receptors.

Indicated for use of ADHD and Narcolepsy.

Side Effects:

1. Bladder pain

2. Bloody or cloudy urine

3. Difficult burning urination

4. Fast, irregular heartbeat

5. Lower Back pain

6. Chills

7. Fever

Consideration: Monitoring the patient to see how they react to the medication if they need to reduce or increase the dose or medication

DI: Not recommended to be used with Antidepressants, Triptants or other stimulants

Source: https://my.clevelandclinic.org/health/treatments/11766-adhd-medication, https://www.mayoclinic.org/drugs-supplements/dextroamphetamine-and-amphetamine-oral-route/description/drg-20071758#drug-side-effects, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cns-stimulant 

Common Drugs: 

• Dabigatran (Pradaxa)

•  Rivaroxaban (Xarelto) 

• Warfarin (Coumadin)

Mechanism of Action: 

• Dabigatran is used to lower the chance of a stroke in people with a medical condition. It also is used to prevent blood clots in the lungs or in the veins.

• Rivaroxaban prevents or treats blood clots. It is also used to lower the risk of stroke or heart attack for patients with heart or peripheral artery disease.

• Warfarin prevents and treats thrombosis and myocardial infarction. This medication inhibits vitamin K-dependent clotting factors and reduces clotting capability.

Indications: 

Dabigatran is used to treat thrombosis and pulmonary embolism.

Rivaroxaban is used to treat thrombosis and pulmonary embolism. It also prevents thrombosis and pulmonary from happening again after treatment.

Warfarin is used to treat thrombosis and pulmonary embolism, as well as myocardial infarction.

Side Effects: 

Dabigatran side effects are back pain, indigestion, numbness, tingling, nausea, stomach pain/upset stomach, and heartburn.

Rivaroxaban side effects are bloody stools, bleeding gums, prolonged bleeding from cuts, vomiting, back pain, tarry stools, burning or itching feeling, HA, difficulty breathing, dizziness, and red or dark brown urine

Warfarin side effects are Unusual bruising, Pain or swelling in the joints, bloody stools, bleeding gums, vomiting, tarry stools, HA, red or dark brown urine, and Vision changes.

Patient Considerations:

When taking anticoagulant medicines you want to be cautious of becoming injured, may cause bad bruising or cuts. You would want to try to avoid minor injuries, cuts and grazes. You can do this by using a soft toothbrush when brushing to prevent bruising or bleeding. 

Drug Interactions:

Anticoagulants can interact with antibiotics, NSAIDs, antifungals, and certain antidepressants. Pharmacists should monitor patients frequent blood work and for adverse effects or side effects from them using the medication.

Links:

https://my.clevelandclinic.org/health/treatments/22288-anticoagulants

https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/in-depth/warfarin-side-effects/art-20047592

https://pmc.ncbi.nlm.nih.gov/articles/PMC7801335/

Antigout medications are prescribed for the treatment of gout.

Common Drugs: 

• indomethacin - Indocin (NSAID: most common)

• allopurinol - Zyloprim

• colchicine - Colcrys

• febuxostat - Uloric

Other treatments: NSAIDs, Corticosteroids (if a patient cannot tolerate NSAIDs)

Mechanism of Action: 

Antigout medications reduce uric acid production, facilitate the excretion of uric acid by blocking its reuptake in the kidneys, and reduce inflammation.

Indications: 

Antigout medications are used to treat gout.

Side Effects: 

• allopurinol - stomach upset, nausea, diarrhea, drowsiness

• colchicine - Causes nausea, diarrhea, vomiting

• febuxostat - nausea

Patient Considerations: 

• Boxed Warning for febuxostat: May lead to stroke or heart related problems

• Adverse drug interactions for allopurinol (Zyloprim): Hepatotoxicity and liver toxicity; skin rash

• Monitor liver function

• Increase fluid intake and take after a meal

Drug Interactions: 

• Colchicine - Avoid grapefruit and grapefruit juice

Link:

https://www.rxlist.com/how_do_antigout_agents_work/drug-class.htm