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.

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.

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

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

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

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

.

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/

• 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

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

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/

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

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

•  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/
  

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

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

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}

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.

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/

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

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

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

• 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

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/

• 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).

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

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

• 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/

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

• 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