Other

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Anticholinergics

scopolamine=Hyoscine, Transderm Scop: AVL: Skin patch, IM, IV, SubQ. IND: Injection used to reduce respiratory secretions at end of life. Patch used for motion sickness, postoperative naus/vom, hypersalivation. MOA: CNS depressant by antagonizing muscarinic receptors. AE: Dry mouth29%, drowsiness17%. CI: Children. PK: Patch: Onset=4-12h. Priming dose of 140ug is released from the adhesive layer. Then 5µg/h for 72h via controlled release membrane. After removal of patch, excretion from the skin site continues for up to 12h w/ effects lasting up to 24h. SubQ: t1/2=3.5h. IM:t1/2=1h. Onset=15-20min IV: t1/2=1h. Onset=5-10min. Metabolized hepatically and excreted in urine. <10% of parent drug excreted unchanged in urine. DOS: Motion sickness: Apply 1 patch to dry, hairless skin behind the ear ~12h before antiemetic effect is required. Can be left up to 72h prn but should be removed when travel is complete. Hypersalivation: (not HC-approved use): 1 patch applied q72h (change application side each time). Postoperative N/V: 1 patch applied the evening before surgery or 4h before end of surgery. OTH: Schedule II.

 

Anti-Gout

colchicine: IND: Gout. DOS: Acute gout Tx: 1.2mg initially. Then 0.6 mg 1h later (total=1.8mg colchicine). Gout prophylaxis=0.6mg once/d or BID. Can start prophylaxis 12h after the last treatment dose. OTH: Not recommended if presenting 36h after onset of symptoms.

 

Cannabinoids

cannabis=marijuana: EVD: Effective for: chronic pain in adults, naus and vom in Cancer pts. Likely improves: MS spasticity symptoms, sleep in the short term. ADM: AE: Drowsiness/fatigue, dizziness, dry mouth, cough/phlegm/bronchitis (smoking only), anxiety, naus, cognitive effects, euphoria, blurred vision, euphoria, blured vision, headache, orthostatic hypotension, toxic psychosis/paranoia, depression, ataxia/dyscoordination, tachycardia, diar. Lower level of memory and attention. PRG: Lowers birth weight. PK: VAPORIZATION/SMOKING: Onset=5-10min. Duration=1-4hrs. ORAL: Onset=60-180min. Duration=6-8hrs. OTH: Possible link to testicular cancer. Not linked with lung cancer.

nabilone=Cesamet: AVL: PO. IND: Chemo induced N + V. AE: Drowsiness, dizziness, dry mouth, euphoria/high, HA, insomnia, anxiety, depression, memory loss. PRG: CI. LAC: CI. DOS: Std= 1-2mg BID. Taken 1-3h before chemo. OTH: May be addictive. Don’t drive while taking.

 

Dihydrofolate Reductase Inhibitor

methotrexate=Metoject: IND: CD. MOA: Inhibits dihidrofolate reductase. EVD: Effective at maintenance of remission. Possibly effective for induction. AE: Naus, flu-like aches, HA, oral ulcers, bone marrow and liver toxicity, pneumonitis, immunosuppression, lymphoma. PK: Time to effect=4w. DOS: 25mg injection q1w. OTH: Can be used w/ 20mg prednisone.

 

EPO Receptor Agonist

epoetin alpha=Eprex: AVL: IV and SubQ. OTH: SubQ has longer half life (more efficient use of drug).
darbopoetin alpha=Aranesp: AVL: IV and SubQ. PK: t1/2: IV & SubQ=30h.


 

Monoclonal Antibodies (MABs)

adalimumab=Humira: AVL: SubQ (self-injection). IND: Psoriasis. EVD: Best evidence for inducing fistula closure. AE: Naus, injection site rxn, opportunistic infections, reversible lupus-like syndrome, worsening heart failur, lymphoma, CNS demyelinating disorders. DOS: CD: Induction: 4 injections on day 1 (160mg), 2 injections day 15 (80mg), 1 injection day 29 (40mg). Maint=1 injection q2w (40mg).


certolizumab pegol=Cimzia: AVL: SubQ (professional injection). IND: Not approved in Canada for CD. AE: Naus, injection site rxn, opportunistic infections, reversible lupus-like syndrome, worsening heart failure, lymphoma, CNS demyelinating disorders. COS: $700/dose. DOS: Injection q4w.


erenumab=Aimovig: AVL: SubQ70mg/mL 1mL single-dose autoinjector. IND: Migraine prevention in adults w/ > 4 migraine days/month. MOA: Competes w/ calcitonin gene-related peptide (CGRP) for binding to CGRP receptors, which antagonizes CGRP receptor function. CGRP, a neuropeptide, modulates nociceptive signalling and causes vasodilation, which has been associated with migraine pathophysiology. ADM: Can be self-administered w/ training. Leave injector at room temp for >30min before injection. Can be injected in abdomen, thigh or upper arm. Rotate injection sites. AE: Site rxns (pain, erythema, pruritus), const, muscle spasms, generalized pruritus/pruritic rash. CI: <18yo. DI: None. PK: Not metabolized or effect on CYPs. AUX: Store in refrigerator. Do not shake. DOS: Std=70 mg SubQ once/month. Max=2 injections (140mg) once/month. OTH: Drug class: CGRP antagonist. Keep in refridgerator. Stable for 14d once reaches room temp (<25C). Don't freeze or shake.
golimumab=Simponi: AVL: SubQ. COS: $1600/50mg dose. DOS: Flare up=200mg then 100mg 2w later. Maint=50mg q4w.


infliximab=Remicade: AVL: IV. IND: Psoriasis. AE: Naus, injection site Rxn, opportunistic infections, reversible lupus-like syndrome, worsening HF, lymphoma, CNS demyelinating disorders. COS: $1000/100mg dose. DOS: Induction=5mg/kg at 0, 2, and 6w. Maint=5mg/kg q8w. If no/partial response, try 10mg/kg.


secukinumab: IND: Psoriasis.


ustekinumab: IND: Psoriasis.


 

Muscle Relaxers

cyclobenzaprine=Flexeril: IND: Short term (<3 months) treatment of muscle spasms. AE: Drowsiness/fatigue35%, dry mouth25%. CI: MAOI in last 2w. PK: t1/2=18hrs. F=0.4 tmax=7.5hrs OTH: Similar structure and AEs to TCAs.

 

Smoking Cessation - Nicotine Replacement Therapy (NRT)

IND: 1st line for smoking cessation. MOA: Mimics nicotine levels from smoking. EVD: HC recommends trying NRT first. 12 month efficacy=17%. ADM: Can combine w/ smoking to decrease # of cigarettes (could do 2w taper or start on quit day). AE: Headache, naus, insomnia, light headedness, irritability, vivid dreams. DI: Don’t combine with varenicline. DOS: Decrease dose over 3-6 months.
PATCHES
Nicoderm=Habitrol: AVL: 7, 14, 21mg/d patches. ADM: Wear for 24h and rotate site. Don’t cut Nicoderm patch. Can take off before bed but not recommended. AE: Skin irritation. CI: Skin disease. PRG: Wear 16h/d to decrease exposure. DOS: 6w of 21mg then 2w of 14mg then 2w of 7mg. If <10cigarettes/d start with 14mg. May need additional NRT for cravings.


GUMS
Nicorette=Thrive: AVL: 2, 4mg gum. ADM: Bite, bite, park on side of cheek for 1min. 1 gum should last 30min. AE: Hiccups, sore jaw, mouth ulcer. CI: Dental diseases. PRG: Safest smoking cessation option in prg. PK: Peak=30min. DOS: Usual=10gums/d. Max=20gums/day. Use 4mg gum if smoking <30min after waking up. OTH:


LOZENGES
Nicorette=Thrive: AVL: 2, 4mg lozenges. ADM: Dissolve over 20-30min. AE: Hiccups, heartburn, mouth/throat irritation. DOS: Based on time of first cigarette. Usual=8/d. Max 15/d. OTH: Delivers more nicotine vs. gum.


SPRAYS
Nicorette QuickMist: AVL: 1mg/spray. AE: Tingling lips, hiccups, bad taste. DOS: 1-2 sprays q30-60min. Max 2 sprays/time, 4sprays/hr, 64 sprays/d.


INHALERS
Nicorette: AVL: 4mg inhaler. MOA: Mimics cigarette. AE: Mouth/throat irritation66%, cough, rhinitis. COS: Most expensive NRT option. DOS: 6-12 cartridges/d. 20min of active puffing (80 deep breaths).

 

Smoking Cessation (Other)

varenicline=Champix: AVL: PO (tab0.5, 1mg). IND: Smoking cessation. MOA: Bdlocks and partially activates nicotinic receptors. Agonist decreases cravings and withdrawal. Antagonist decreases pleasure from smoking. EVD: Best quit rate vs all smoking cessation options. ADM: T w/ food. AE: Naus30%, vom, insomnia (take 2nd dose w/ supper), vivid dreams18%, mood changes, suicidal ideation. CI: Prg, mood disorders. DI: Don’t combine with NRT. Minimize alcohol as it could lead to depression. PK: t1/2=33h. DOS: 0.5mg OD x 3d then 0.5mg bid x 4d then 1mg BID x12w. Start 1-2w before quit date. OTH: Schedule I (Need Rx).

 

Steroids

dexamethasone=Decadron: AVL: IV, IM, PO. IND: Chemotherapy induced N + V (increases effect of ondansetron.).
ADM: T w/ food. AE: fluid retension, thrush, bone loss, cataracts, indigestion, muscle weakness, back pain, bruising, increased glucose, weight gain, insomnia. PRG: FDA cat C. PK: Induces and metabolized by 3A4. Duration=3d.
prednisolone: EVD: Used for 4w in alcoholic liver disease. Original study had a short term mortality benefit with a NNT of 5 at 4w. Later studies showed it was less effective short term and had no effect longer term. AE: Infection.

 

Weight Loss Agents

Contrave=naltrexone+bupropion: AVL: PO (extended release tab containing naltrexone8mg+bupropion90mg. IND: Used w/ diet and exercise to reduce weight in people >18yo >30kg/m2 (obese) or >27kg/m2 (overweight) w/ 1 weight related condition (ex. T2DM, HTN, dyslipidemia). MOA: Thought to act on hypothatlamus which regulates apetite and the mesolymbic dopamine circuit (reward system). EVD: After 56w, people using Contrave lost 5.5kg vs placebo 1.4kg. Doesn't have evidence for cardiovascular, mortaliy or morbidity health. ADM: Should not be taken w/ high-fat meals. AE: Naus32.5%, constipation19.2%, headache17.6%, vomiting10.7%, dizziness9.8%, dry mouth8.1%, seizurerare. CI: Uncontrolled HTN, seizure history, currently using opioids, closed angle glaucoma. PRG: Contraindicated. LAC: Not recommended. DI: MAOIs, thioridazine, tamoxifen. Dose of Contrave should be reduced if using w/ CYP2B6 inhibitors. AUX: Don't crush/chew. MON: BP and pulse measured before starting and at "regular intervals" once started. Assess effectiveness at 12w. If <5% of original weight is lost D/C Tx. DOS: STD ADULT: Taper up to the max dose=2 tabs bid using this schedule: 1 tab am x 7d, then 1 tab bid x7d, then 2 tabs am and 1 in evening x 7d, then 2 tabs bid. PEDIATRIC (<18yo): Not indicated. GERIATRIC (>65yo): Use w/ caution. HEPATIC IMPAIRMENT: Max= 1 tab in am for mild or moderate impairment. RENAL IMPAIRMENT: Max=1 tab BID for mod to severe impairment.
OTH: Contains lactose.

 

Xanthine Oxidase Inhibitor

allopurinol=Zyloprim: AVL: PO tab100,200,300mg. IND: Gout, Tx/prevention of uric acid nephropathy. MOA: Reduces uric acid concentrations in both serum and urine by inhibiting the production in the body. AE: Skin rash (SJSrare). PK: t1/2: allopurinol=1-3h. oxypurinol=12–30h. Onset=2-3d. F=80-90%. PB=0. Elimination: Renal: allopurinol=5–7%, oxypurinol=70%. Fecal=20%. Max decreases of uric acid in 1–3w. MON: Serum urate concentrations should be monitored. ULN=430µM for men/postmenopausal women and 345 µM for premenopausal. Can target <300uM in severe gout and <360uM for mild-mod gout. DOS: Adj for renal fxn. Gout: Starting dose=100mg/d. Std=300mg/d titrated to urate conc. Max=800mg/d. For tolerability divide doses >300mg 2–3 times/d. CrCl 10-20mL/min=100mg/d. CrCl<10mL/min=100mg q2–3d. OTH: Both allopurinol and its active metabolite oxypurinol are active.

 

AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:
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AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:


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AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH: