The Top 200 Prescribed Drugs

Note: 199 Pravastatin (Pravachol®) has been covered in a previous episode (105)  Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 200 Ranitidine (Zantac®) (http://thestudentpharmacist.com/wp-content/uploads/200_Ranitidine.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Ranitidine (Available) * Brand: Zantac® * Mechanism of Action * Histamine H2 Antagonsist (H2 Blocker) * Inhibits gastric acid secretion by blocking H2-receptors on the gastric parietal cells * Indication(s) * Duodenol or gastric ulcer * GERD (gastroesophogeal reflux disease) * Erosive esophagitis * Hypersecretory conditions * H. Pylori eradication (as part of a multidrug regimen) * Heart burn and indigestion * Sour stomach * Dosage form(s) * Capsule * 150, 300 mg * Premixed infusion solution * 50 mg * Injection solution * 25 mg/mL * Oral Syrup * 15 mg/mL * Tablet * 75 [OTC], 150 [OTC], 300 mg * Effervescent tablet for solution * 25 mg * Adult Dosing * Depends on the indication * For most indications (GERD, ulcers, H. pylori, erosive esophagitis maintenance) * Usual dose is 150 mg twice daily * For erosive esophagitis treatment: 150 mg 4 times/day * For OTC use in preventing heartburn: * 75 mg 30-60 min before eating or drinking food that may cause heartburn. * Max dose: 150 mg in 24 hours * Should not self treat for > 14 days * See a doctor for long-term treatment * For patients with renal impairment: Creatinine clearance (CrCl) 50 years of age, although rare, has been documented with the use of ranitidine * Fully reversibly, and usually clears within 4 days after discontinuation * Relief of symptoms does not eliminate the presence of a gastric tumor or malignangy * Adjust dose renal impairment with a CrCl 2 weeks * If longer treatment is needed, it is recommended to see a doctor to make sure there is no other underlying cause of the symptoms * Make sure the patient knows dosing schedule, usually twice daily * Common side effects include GI upset, headache, and dizziness

 Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 198 Verapamil (Isoptin®, Verelan®) (http://thestudentpharmacist.com/wp-content/uploads/198_Verapamil.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Verapamil (available) * Brands: * Calan®, Covera-HS®, Isoptin®, & Verelan® * Mechanism of Action * Non-dihydropyridine (Non-DHP) Calcium Channel Blocker (CCB) * Inhibits calcium from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization * This causes vasodilation in these areas, increases myocardial oxygen delivery, and slows conduction of the AV node in the heart * Non-DHP CCBs work more in the heart, as opposed to the periphery, as compared to DHP CCBs, such as amlodipine. * Indication(s)       * Hypertension * Angina pectoris * Supraventricular tachyarrhythmia (SVT) * Dosage form(s) * Sustained release caplets (Calan®) * 120, 180, & 240 mg * Extended release capsule * 120, 180, & 240 mg * Extended release, controlled onset capsule (Verelan®) * 100, 200, & 300 mg * Sustained release capsule (Verelan®) * 120, 180, 240, and 360 mg * Injection solution: * 2.5 mg/mL * Oral tablets (Calan®) * 40, 80, & 120 mg * Extended release tablets * 120, 180, & 240 mg * Extended release, controlled onset tablets (Covera-HS®) * 180, 240 mg * Sustained release tablets (Isoptin® SR) * 120, 180, 240 mg * Adult Dosing * Angina * Immediate release (IR) Initiate 40-120 mg TID (three times/day) * Usual dose range: 80-160 mg TID * Extended release (ER): Initiate at 180 mg/day given at bedtime * Dose can be increased at weekly intervals up to a max of 480 mg/day * Hypertension * Immediate release:  80 mg TID * Usual dose range: 80-320 mg/day * Sustained release (SR) Typical dose range is 120-480 mg/day as a single or divided doses * There is no evidence for additional benefits with doses > 360 mg/day * Extended release: Usual dose range 120-360 mg once daily given at bedtime * Pharmacokinetics * Onset of action (immediate release): 1-2 hours * Duration of action (immediate release): 6-8 hours * Metabolized in the liver via CYP isoenzymes * 3A4 inhibitor * Time to peak concentration * IR: 1-2 hours * ER: ~11 hours * SR: ~5-9 hours (depending on brand) * Excreted in the urine mainly, and feces, primarily as unchanged drug * Contraindication(s) * Hypersensitivity * Severe left ventricular dysfunction * Hypotension (being a systolic BP

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 197 Benazepril (Lotensin®) (http://thestudentpharmacist.com/wp-content/uploads/197_Benazepril.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Benazepril (available) * Brand: Lotensin® * Mechanism of Action * Angiotensin Converting Enzyme (ACE) Inhibitor * Benazepril is a prodrug that is metabolized in the liver to its active form, benazeprilat * Angiotensin converting enzyme (ACE) normally convert angiotensin I to angiotensin II, which is a potent vasoconstrictor * ACE-Is blocks this conversion * This reduction in angiotensin II also leads to reduced aldosterone secretion, which decreases sodium and water reabsorption * Decreasing angiotensin II and aldosterone also decreases ventricular remodeling, myocardial fibrosis, myocyte apoptosis, cardiac hypertrophy and norepinephrine release * The decrease in aldosterone can lead to an increase in serum potassium * Also causes vasodilation of the renal efferent arteriole which can decrease proteinuria (especially in patients with Diabetic nephropathy) and is considered renal protective * Indication(s)   * Hypertension * Dosage form(s) * Tablets * 5, 10, 20, & 40 mg * Adult Dosing * Hypertension: * Intiate at 10 mg/day (or 5 mg/day if the patient is already on a diuretic) * Titrate up to 80 mg/day as needed and tolerated * Can be given as a single daily dose or divided for twice a day dosing and should be based on blood pressure readings throughout the day * Notes: * Renal impairment: Initiate at 5 mg/day if creatinine clearance (CrCl) 35% from baseline

Note: 195 Naproxen (Aleve®) has been covered in a previous episode (135) Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp ...

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 194 Lidoderm® (Lidocaine) (http://thestudentpharmacist.com/wp-content/uploads/194_Lidocaine.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Topical lidocaine * Brand: Lidoderm® * Many other dosage forms and brand names... some OTC, some RX * We will focus on topical lidocaine in this episode * Mechanism of Action * Blocks initiation and conduction of nerve impulses by decreasing the permeability of neuronal membranes to sodium * Indication(s)    * Topical lidocaine is used as an local anesthetic * Dosage form(s) * Lidoderm® specifically is a topical patch: 5% * Other topical forms include aerosol foams and sprays, creams, gels, jellys, lotions, ointments, and solutions ranging in strength from 2-9.6% * Adult Dosing * Lidoderm, specifically: Apply patch to painful area * ≤ 3 patches can be used in a single application * Patches can be left in place for ≤ 12 hours in a 24 hour period * Contraindication(s) * Hypersensitivity * Precaution(s) * Application to broken or inflamed skin may lead to increased systemic absorption (use with caution in this case) * Store and dispose of the patches out of reach of children to avoid ingestion * Adverse Drug Reactions * Most common * Generally well tolerated * Local irritation * Paradoxical skeletal pain can develop in rare cases * MAJOR Drug Interactions * Avoid use with conivaptan, thioridazine, and tolvaptan * Pregnancy Category/Breast feeding * Category B * Rated “compatible” with breastfeeding by the American Academy of Pediatrics * Safety/Efficacy Monitoring * Pain management * Local irritation * Major Counseling Points * Apply patches directly to the most painful area * Up to 3 patches can be applied at the same time * Patches should be left on no more than 12 hours in a day * So 12 hours on, 12 hours off, at most * Can use medical tape or ACE bandages over the patch if needed to hold it in place (don’t wrap to tight) * Patches can be cut if needed to cover area * Generally well tolerated, but you may get some local skin irriation * Remove patch and do not reapply until irritation is gone if this is an issue * Let you doctor know if pain seems to get worse with use of Lidoderm® * Let your doctor or pharmacist know if you experience any severe, prolonged, or intolerable side effects References: * Lidocaine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 25]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Lidoderm®. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2011, cited 2011 Aug 25].  [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ (https://online.epocrates.com/noFrame/) * Characteristics of transdermal patches. Pharmacist's Letter/Prescriber's Letter 2008;24(7):240711. Available from: http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=RITEAID&s=PL&pt=6&fpt=31&dd=240711&pb=PL&searchid=29112546 (http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=RITEAID&s=PL&pt=6&fpt=31&dd=240711&pb=PL&searchid=29112546) * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf  

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 190 Evista® (Raloxifene) (http://thestudentpharmacist.com/wp-content/uploads/190_Evista.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Raloxifene (not available) * Brand: Evista® * Mechanism of Action * Selective Estrogen Receptor Modulator (aka SERM) * Affects some, but not all, of the receptors that are acted upon by estrogen * Actually blocks, and acts like, estrogen at these sites in order to prevent bone loss (by decreasing resorption and increasing bone mineral density) as well as potentially blocking the effect of estrogen in breast and uterine tissues (where excess estrogen can lead to cancer) * Indication(s) * Osteoporosis in postmenopausal women (treatment and/or prevention) * Invasive breast cancer risk reduction in postmenopausal women with either osteoporosis or high risk of breast cancer * Dosage form(s) * Tablet: 60 mg * Adult Dosing * 60 mg/day * Pharmacokinetics * Onset of action: ~8 weeks * Very low bioavailability: ~2% * Half life elimination: ~30 hours * Excreted primarily in the feces * Black Box Warning(s) * Evista® may increase the risk of DVT or PE * Use is contraindicated in patients with current or history of venous thromboembolism * Evista® may increase risk of death due to stroke in women with coronary heart disease or risk of such events * Contraindication(s) * Venous thromboembolic (VTE) history * Pregnancy and breastfeeding * Again, raloxifene it is only for women who are postmenopausal * Precaution(s) * Use with caution in patients with hepatic and/or renal impairment (safety not yet established) * Triglycerides (TGs) may be increased, especially if patients had increased TGs in response to oral estrogens in the past * Adverse Drug Reactions * Most common (> 10%) * Peripheral edema * Hot flashes * Arthralgia * Muscle cramps/spasms (most often occurring in the leg muscles) * Flu syndrome * Infections * MAJOR Drug Interactions * Does not appear to be many significant drug interactions * Evista® may decrease the effects of levothyroxine * Bile acid sequestrants may decrease the effects of raloxifene * Separate dosing by ≥ 4 hours * Pregnancy Category/Breast feeding * Category X (contraindicated) * Contraindicated in breast feeding * Safety & Efficacy Monitoring * Bone mineral density * Lipid panel * Monitor for s/s of deep vein thrombosis (DVT), pulmonary embolism (PE) * Major Counseling Points * Evista is taken once daily and is only meant for postmenopausal women * Common side effects include edema/welling, hot flashes, and muscle cramps/spams * Avoid prolonged periods of restricted movement (due to risk of DVT, PE) * Let your doctor or pharmacist know immediately if you experience any of the following (which are often referred to as ACHES): * A - Severe Abdominal pain * C - Chest pain or shortness of breath * H - Severe Headache * E - Eye problems or visual disturbances * S - Severe pain in the calf or thigh * As always, let your doctor or pharmacist know if you experience any severe, intolerable, or prolonged side effects References: * Raloxifene. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 25]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Evista®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 189 Suboxone® (Buprenorphine & Naloxone) (http://thestudentpharmacist.com/wp-content/uploads/189_Suboxone.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Buprenorphine & Naloxone (not available) * Brand: Suboxone® * Mechanism of Action * Buprenorphine * Opioid analgesic * Binds to mu opiate receptors in the CNS * Naloxone * Opioid antagonist * Competes and displaces narcotics from opioid receptor sites * Antidote used in opioid overdose * Indication(s) * Treatment of opioid dependence * Dosage form(s) * Sublingual film and tablets * 2 mg buprenorphine, 0.5 mg naloxone * 8 mg buprenorphine, 2 mg naloxone * Few notes comparing the sublingual film vs tablet * The film has a better taste and dissolves faster * Although they come in the same strengths, the film does have a slightly higher bioavailability * Adult Dosing * Day 1: Initiate at 4 mg * If withdrawal symptoms are not relieved, the dose may be repeated after ≥ 2 hours * Max on day 1: 8 mg * Day 2: If withdrawal symptoms develop, increase the day 1 dose by 4 mg * If withdrawal symptoms do NOT develop, use the same dose as day 1 * Either way, If withdrawal symptoms are not relieved, the dose may be repeated after ≥ 2 hours * Max on day 2: 16 mg * Subsequent days: * If withdrawal symptoms have not developed, then use the established dose * If withdrawal symptoms do develop, increse the dose by 2-4 mg/day until symptoms are relieved. * Usual daily dose: 4-24 mg * Max daily dose 32 mg/day * Note: Suboxone should only be used for induction in patients who are dependent on short-acting opioids and whose last dose with ≥ 12 hours prior to induction * Buprenorphine monotherapy should be used for induction in patients dependend on long-acting opioids.  The combination can then be used for maintenance therapy once an adequate daily dose is established * Pharmacokinetics * The sublingual film appears to have greater bioavailability as compared to the sublingual tablets * Half-life * Buprenorphine: 24-42 hours * Naloxone: 2-12 hours * Contraindication(s) * Hypersensitivity * Precaution(s) * May cause CNS depression, which can impair physical and mental abilities * Hepatic events have been reported with buprenorphine use including hepatitis and increased liver function tests * Use with caution in patients with pre-existing liver dysfunction * Get baseline liver function tests, and test periodically throughout therapy * Also use with caution in patients with adrenal insufficiency, biliary tract dysfunction, bowel obstruction, alcoholism, benign prostatic hyperplasia, psychosis, thyroid dysfunction, as well as any respiratory disease * Adverse Drug Reactions * Most common * Headache * Vomiting * Withdrawal symptoms * Diaphoresis * Vasodilation * MAJOR Drug Interactions * Avoid use with atazanavir, conivaptan, and MAO inhibitors * Suboxone may increase the effects of alcohol, CNS depressant, SSRIs, and MAO inhibitors * Suboxone’s effects may be increased when used with atazanavir, conivaptan, 3A4 inhibitors, hydroxyzine, and succinylcholine * Suboxone may decrease the effects of opioid analgesics (which makes sense if you think about it) as well as atazanavir * Pregnancy Category/Breast feeding * Category C * Buprenorphine enters breast milk, and is therefore not recommended in breast feeding * Safety Monitoring

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as...

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 182 (Ciprofloxacin; Cipro®), 183 (Prednisone), and 184 (Atenolol; Tenormin®) have been covered in previous episodes. 185 Meclizine (Antivert®) (http://thestudentpharmacist.com/wp-content/uploads/185_Meclizine.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Meclizine (generic is available) * Brand: Antivert® (Rx) * OTC Brands include: Bonine®, Dramamine® Less Drowsy Formula, Trav-L-Tabs® * Mechanism of Action * 1st generation antihistamine and antiemetic * Blocks the chemoreceptor trigger zone via central anticholinergic action * Also decreases excitability and blocks conduction in the middle ear * Indication(s) * Motion sickness * Vertigo * Dosage form(s) * Caplets: 12.5 mg * Tablets: 12.5, 25, and 50 mg * Chewable tablets: 25 mg * Adult Dosing * Motion sickness * 12.5-25 mg ~1 hour before traveling * Dose may be repeated every 12 hours if needed * Vertigo * 25-100 mg/day in divided doses * Pharmacokinetics * Onset of action: ~1 hour * Duration: 8-24 hours * Metabolized in the liver * Excreted in the urine as metabolites and feces as unchanged drug * Contraindication(s) * Hypersensitivity * Precaution(s) * CNS depression may occur, which can lead to impairment of physical and mental abilities * Use with caution in patients with asthma, narrow angle glaucoma, BPH or urinary stricture, and pyloric or duodenal obstruction * All of these condition may be exacerbated by meclizine * Also use with caution in elderly patients (who may be more sensitive to the adverse effects) and children

Note: 177 (Atenolol; Tenormin®), 178 (Metformin; Glucophage®), 179 (Lisinopril/Hydrocholorothiazide; Prinzide®, Zestoretic®), & 180 Ciprofloxacin (Cipro®) have been covered in previous episodes. 181 Folic Acid (http://thestudentpharmacist.com/wp-content/uploads/181_Folic_Acid.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Folic Acid * Brand: Folacin-800 (OTC) * Folic acid can be found in most, if not all, multivitamins (400 mcg) and prenatal vitamins (1 mg) * Mechanism of Action * Folic acid is utilized in the body to form many coenzymes as well as in the maintenance of erythropoiesis, and WBC and platelet production. * Folic acid can also enhance the elimination of formic acid, which is a toxic metabolite of methanol * Folic acid deficiency in pregnancy can lead neural tube defects of the fetus * Because of this, it is important for any woman trying to become pregnant or of child bearing age to get adequate folic acid before becoming pregnant * Indication(s) * Megaloblastic and macrocytic anemais (due to folate deficiency) * Prevention of neural tube defects in pregancy * Dosage form(s) * Injection solution: 5 mg/mL * Tablets: 0.4, 0.8, & 1 mg * Adult Dosing * Recommended dietary intake (RDA): 400 mcg/day * Anemia: * 400 mcg/day * Increase dose to 800 mcg/day if the patient is pregnant or lactating * Prevention of neural tube defects in pregnancy (all women of childbearing age) * 400-800 mcg/day * Increase the dose to 4 mg/day if the patient has a family history of neural tube defects * Pharmacokinetics * Peak effect/levels: ~1 hour * Metabolized in the liver * Excreted in the urine * Contraindication(s) * Hypersensitivity * Precaution(s) * Folic acid should not be used as monotherapy for pernicious, aplastic, or normocytic anemias if there is a vitamin B12 deficiency * Injection solution contains the preservative benzyl alcohol (1.5%), which has been associated with “gasping syndrome” in neonates * Adverse Drug Reactions * Well tolerated for the most part. May see: * Allergic reaction * Bronchospasms * Fluching or erythema * Malaise * Pruritus or rash * MAJOR Drug Interactions * Avoid coadministration of Folic Acid with Raltitrexed (Antineoplastic agent) * Folic acid can decrease the effects of Raltitrexed * Pregnancy Category/Breast feeding * Category A (recommended) * Compatible (recommended) * Safety Monitoring / Efficacy Monitoring * Anemia (if indication given for) * Side effect profile * Major Counseling Points * All women of child bearing age should get adequate folic acid intake (at least 400 mcg/day) * This is recommended to help prevent neural tube defects * Can be obtained with a multivitamin daily * Generally well tolerated with very minimal side effects * As always, report any severe, intolerable, or prolonged side effects to your doctor or pharmacist * Note: * According to an article published in the Pharmacist Letter in January or 2010, high doses of folic acid (being ≥ 800 mcg) for prolonged periods of time may be linked to increased risk of cancer * This comes from studies in which high doses of folic acid was given to patients with heart disease. This did not improve outcomes, but these patients do seem to have more cancers... “about 3 more cancers a year for every 1000 patients taking folic acid 800 mcg daily for about 3 years” according to the article * That said, it is still recommended for most patients to take up to 400 mcg/day and for women to take 400-800 mcg/day during pregnancy References: * Folic Acid. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 10]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Folic Acid.

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 174 (Trazodone; Oleptro®) & 175 (Endocet®; Oxycodone/Acetaminophen) has been covered in a previous episode 176 Combivent® (ipratropium & albuterol) (http://thestudentpharmacist.com/wp-content/uploads/176_Combivent.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Ipratropium & Albuteral (Available as solution for nebulization) * Brands: * Combivent® (aerosol for oral inhalation... inhaler) * DuoNeb® (solution for nebulization) * Mechanism of Action * Ipratropium * Anticholinergic agent * Blocks acetycholine from binding in the bronchial smooth muscles which causes bronchodilation * Albuteral * Beta agonist * Stimulates beta-2 receptors which relaxes bronchial smooth muscle * Indication(s) * COPD * Should only be used in patients who are already on a bronchodilator and continue to have bronchospasms, and therefore need a 2nd bronchodilator * Dosage form(s) * Aerosol for oral inhalation (Combivent®) * 18 mcg ipratropium / 90 mcg albuteral per inhalation * Solution for nebulization (generic and DuoNeb®) * 0.5 mg ipratropium / 2.5 mg albuterol per 3 mL * Adult Dosing * Aerosol for oral inhalation (Combivent®) * 2 inhalation 4 times/day * Additional doses can be given if needed * Max daily doses should not exceed 12 inhalations * Solution for nebulization (generic and DuoNeb®) * Initiate at 3 mL every 6 hours * Max: 3 mL every 4 hours * Pharmacokinetics * Ipratropium * Onset of bronchodilation: ≤ 15 minutes * Peak effect is seen at 1-2 hours * Duration: 2-5 hours * Albuteral * Peak effect: ~ 30 minutes * Duration of action: 3-4 hours * Contraindication(s) * Hypersensitivity * Precaution(s) * Although rare, paradoxical bronchospasm can occur with inhaled beta agonist * Something to look out for if patient is seems to get worse with use of their inhaler * Immediate hypersensitivity reactions can occur and should be monitored for with initial use of albuterol * Beta agonist can cause CNS excitation * Use with caution in patients with a history of seizures or CV conditions (such as HTN or HF) * Beta agonist can increase serum glucose * Something to be aware of with diabetic patients * Use with caution in BPH (benign prostatic hyperplasia) or bladder neck obstruction * Ipratropium can potentially exacerbate the condition * Adverse Drug Reactions * Most common * Throat irritation and cough * Dizziness * Nausea * HA * Palpitations and tachycardia * MAJOR Drug Interactions * Beta blockers as well as alpha and beta blockers can decrease therapeutic effects of beta agonists * TCAs and sympathomimetics may increase adverse effects of Albuterol * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety Monitoring * May want to check BP, HR, and overall cardiovascular health if indicated * May want to check serum glucose and serum potassium if indicated * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Combivent specifically * If using the inhaler for the first time or if has not been used in the past 24 hours, you will need to prime the inhaler * 1st shake the inhaler for ~10 seconds * Then spray 3 actuations into the air away from your face and others * Go over proper inhalation technique * 1st breath out deeply through your mouth

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 172 Boniva® (ibandronate) (http://thestudentpharmacist.com/wp-content/uploads/172_Boniva.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: ibandronate (not available) * Brand: Boniva® * Mechanism of Action * Bisphosphonate * Inhibits osteoclasts, which decreases bone turnover and resorption * This indirectly increases bone mineral density * Indication(s) * Osteoporosis in postmenopausal females * Treatment and prevention * Dosage form(s) * Injection solution: 1 mg/mL (3 mg vial) * Tablets: * Once daily formulation: 2.5 mg * Once-monthly formulation: 150 mg * Adult Dosing * Oral tablets: 2.5 mg once daily or 150 mg once monthly * Treatment or prevention * IV: 3 mg every 3 months * Treatment dose * Notes: * If diet is inadequate, patients should be on supplemental calcium and vitamin D while on bisphosphonates * Vitamin D: 800-1000 Units/day * Calcium: 1200-1500 mg/day * No dosing adjustment is needed in hepatic impairment * Use is not recommended in severe renal impairment: (CrCl 10% * Dyspepsia * Back pain * 1-10% * Hypertension * Headache * Dizziness * Insomnia * GI upset * MAJOR Drug Interactions * No oral drugs should be taken within 60 minutes of Boniva® (ibandronate) * NSAIDs can increase the risk of GI irritation * Pregnancy Category/Breast feeding * Category C * Excretion in breast milk is unknown (use with caution) * Safety and Efficacy Monitoring * Central bone mineral density scan at baseline then 1-2 years after initiation * Serum Calcium and Vitamin D * Blood pressure * Major Counseling Points * Take each dose first thing in the morning with a full glass of water * Remain upright (sitting or standing) for at least 60 minutes after taking and do not take any other oral medications within 60 minutes of taking Boniva® * Patients should avoid alcohol (which can cause or contribute to osteoporosis) * Counsel on main side effects (GI upset, dyspepsia, headache, insomnia, and back pain) * As always, patients should report any persistent, severe, or intolerable side effects to their doctor or pharmacist References: * Ibandronate. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 6]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Boniva®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 165 (Prednisone) and 166 (Lisinopril/Hydrochlorothiazide) have been covered in previous episodes 167 Enalapril (Vasotec®) (http://thestudentpharmacist.com/wp-content/uploads/167_Enalapril.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Enalapril (available) * Brand: Vasotec® * Mechanism of Action * ACE-Inhibitor * Angiotensin converting enzyme (ACE) normally convert angiotensin I to angiotensin II, which is a potent vasoconstrictor * ACE-Is blocks this conversion * This reduction in angiotensin II also leads to reduced aldosterone secretion, which decreases sodium and water reabsorption * Decreasing angiotensin II and aldosterone also decreases ventricular remodeling, myocardial fibrosis, myocyte apoptosis, cardiac hypertrophy and norepinephrine release * The decrease in aldosterone can lead to an increase in serum potassium * Also causes vasodilation of the renal efferent arteriole which can decrease proteinuria (especially in patients with Diabetic nephropathy) and is considered renal protective * Indication(s) * Hypertension * Symptomatic heart failure * Asymptomatic left ventricular dysfunction * Dosage form(s) * Injection solution (enalaprilat): 1.25 mg/mL * Tablets: 2.5, 5, 10, and 20 mg * Adult Dosing * Dose ranges from 2.5 - 40 mg/day * Initiate at lower dose then titrate up as needed, especially in patients with hyponatremia, hypovolemia, severe heart failure, decreased renal function, or those on diuretics * Pharmacokinetics * Prodrug metabolized in the liver to enalaprilat (active) * Onset of action: ~1 hour oral (≤ 15 min IV) * Oral: Peak effect is seen in 4-6 hours and duration is 12-24 hours * Excreted mainly in the urine * Contraindication(s) * Hypersensitivity * Angioedema * Precaution(s) * ACE-Is can cause angioedema at any time during therapy * Especially after 1st dose * ACE-Is are contraindicated if patient experiences angioedema * AAs are at increased risk of developing angioedema * Due to the build up of bradykinin caused by ACE-Is, enalapril can cause chronic cough * Dry and nonproductive * Usually seen withing first months of therapy * Should resolve within a month of discontinuation * If intolerable to patient try switching therapy to an ARB (much less likely to cause cough) * ACE-Is can cause Hyperkalemia * Increased risk in: * Renal dysfunction * DM * Use of potassium sparing diuretics or potassium supplements (salts) * Monitor K levels * Hypotension * Usually seen with first doses * Risk is higher in volume depleted patients * Check volume status to make sure patient is not dehydrated * If hypotension is an issue, decrease dose (don’t discontinue) * Renal Dysfunction * Generally considered renal protective because enalapril and other ACE-Is vasodilate the efferent arteriole of the kidneys which decreases renal pressure * Can cause increase in serum creatinine * DC (ACE-Is or ARBs) if SrCr increases > 35% from baseline * Use with caution in patients with pre-existing renal impairment * Adverse Drug Reactions * Most common * GI upset (N/V/D, constipation * Hypotension, chest pain, syncope * HA, dizziness, fatigue * Rash * Abnormal taste * MAJOR Drug Interactions * NSAIDs * Block effects of ACE-Is and can enhance ADRs (renal impairment) * ASA can be used with ACE-Is if both drugs are indicated * Use ≤ 160 mg of ASA

Today’s episode was sponsored by Lexi-Comp.  To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 163 Propoxyphene/APAP (Darvocet®) was removed from the US market in Nov 2010 164 Doxycycline (Vibramycin®) (http://thestudentpharmacist.com/wp-content/uploads/164_Doxycyline.mp3) Episode Notes (References Below) * Brand/Generic: * Generic is available * There are several name brands, including (not complete): * Adoxa® * Alodox™ * Doryx® * Monodox® * Vibramycin® * Mechanism of Action * Tetracycline derivative antibiotic * Inhibits protein synthesis by binding to the 30S (and potentially the 50S) ribosomal subunit of bacteria * Indication(s) * Susceptible bacterial infections such as: * Lyme disease * Syphillis * Chlamydia * Anthrax * Generally, tetracyclines such as doxycycline are effective against atypical bacrteria, spirochetes, Rickettsial diseases, anthrax, syphillis, and acne * Dosage form(s) * Oral capsules: 50, 100 mg * Variable release capsules: 40 mg (of which 30 mg is immediate release and 10 mg delayed release) * Injection powder (for reconstitution): 100 mg * Powder for oral suspension: 25 mg/5 mL * Oral syrup: 50 mg/5 mL * Oral tablets: 20, 50, 75, 100, & 150 mg * Delayed release tablets: 75, 100 mg * Adult Dosing * Usual dose range 100-200 mg/day as 1 or 2 doses * Pharmacokinetics * Nearly complete absorptions * t1/2 is 12-15 hours * Eliminated in the feces and urine * Contraindication(s) * Hypersensitivity * Children