Medications 1.

Tricor-lipid-lowering agents Indications-With dietary therapy to decrease LDL cholesterol, total cholesterol, triglycerides, and apolipoprotein B in adult patients with hypercholesterolemia or mixed dyslipidemia. With dietary management in the treatment of hypertriglyceridemia (types IV and V hyperlipidemia) in patients who are at risk for pancreatitis and do not respond to nondrug therapy Action- Fenofibric acid primarily inhibits triglyceride synthesis Adverse Reactions- CNS: fatigue/weakness, headache.CV: PULMONARY EMBOLISM, arrhythmias, deep vein thrombosis.GI: cholelithiasis, pancreatitis.Derm: rash, urticaria. MS: rhabdomyolysis. Misc: hypersensitivity reactions. Interactions- anticoagulant effects of warfarin , Concurrent use with HMG-CoA reductase inhibitors risk of rhabdomyolysis (combined use should be avoided), Absorption is by bile acid sequestrants (fenofibrate should be given 1 hr before or 46 hr after), risk of nephrotoxicity with cyclosporine

2. Vancomycin- anti-infectives Indications- IV: Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly useful in staphylococcal infections, including( Endocarditis, Meningitis, Osteomyelitis, Pneumonia, Septicemia, Soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin. PO: Treatment of staphylococcal enterocolitis or pseudomembranous colitis due to Clostridium difficile . IV: Part of endocarditis prophylaxis in high-risk patients who are allergic to penicillin. Action- Binds to bacterial cell wall, resulting in cell death Adverse Reactions- EENT: ototoxicity. CV: hypotension.GI: nausea, vomiting.GU: nephrotoxicity. Derm: rashes. Hemat: eosinophilia, leukopenia.Local: phlebitis.MS: back and neck pain. Misc: HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS , chills, fever, "red man" syndrome (with rapid infusion), superinfection. Interactions- May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs ( aspirin , aminoglycosides , cyclosporine , cisplatin , loop diuretics ).May enhance neuromuscular blockade from nondepolarizing neuromuscular blocking agents . risk of histamine flush when used with general anesthetics in children

3. Zosyn- anti-infectives Indications- Appendicitis and peritonitis. Skin and skin structure infections. Gynecologic infections. Community-acquired and nosocomial pneumonia caused by piperacillin-resistant, beta-lactamase producing bacteria

Action- Piperacillin: Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins. Tazobactam: Inhibits beta-lactamase, an enzyme that can destroy penicillins Adverse Reactions- CNS: SEIZURES (HIGHER DOSES) , confusion, dizziness, headache, insomnia, lethargy.GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, constipation, drug-induced hepatitis, nausea, vomiting.GU: interstitial nephritis. Derm: rashes ( in cystic fibrosis patients), urticaria. Hemat: bleeding, leukopenia, neutropenia, thrombocytopenia. Local: pain, phlebitis at IV site. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS , fever ( in cystic fibrosis patients), superinfection. Interactions- Probenecid renal excretion and blood levels. May alter excretion of lithium. Potassiumlosing diuretics , corticosteroids , or amphotericin B may risk of hypokalemia. risk of hepatotoxicity with other hepatotoxic agents . May half-life of aminoglycosides in patients with renal impairment. May levels and risk of toxicity from methotrexate

4. Haldol- antipsychotics Indications- Acute and chronic psychotic disorders including, schizophrenia, manic states, drug-induced psychoses, Schizophrenic patients who require long-term parenteral (IM) antipsychotic therapy, Also useful in managing aggressive or agitated patients,Tourette's syndrome, Severe behavioral problems in children which may be accompanied by, unprovoked, combative, explosive hyperexcitability Action- Alters the effects of dopamine in the CNS. Also has anticholinergic and alpha-adrenergic blocking activity Adverse Reactions- CNS: SEIZURES, extrapyramidal reactions, confusion, drowsiness, restlessness, tardive dyskinesia. EENT: blurred vision, dry eyes. Resp: respiratory depression. CV: hypotension, tachycardia. GI: constipation, dry mouth, anorexia, drug-induced hepatitis, ileus, weight gain. GU: impotence, urinary retention. Derm: diaphoresis, photosensitivity, rashes. Endo: amenorrhea, galactorrhea, gynecomastia. Hemat: AGRANULOCYTOSIS, anemia, leukopenia, neutropenia.Metabolic: hyperpyrexia.Misc: NEUROLEPTIC MALIGNANT SYNDROME, hypersensitivity 5. Protonix- antiulcer agents Indication- Erosive esophagitis associated with GERD, Decrease relapse rates of daytime and nighttime heartburn symptoms on patients with GERD, Pathologic gastric hypersecretory conditions Action- Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen Adverse Effects- CNS: headache. GI: abdominal pain, diarrhea, eructation, flatulence. Endo: hyperglycemia. Interactions- May absorption of drugs requiring acid pH, including ketoconazole , itraconazole , atazanavir , ampicillin esters , and iron salts. May risk of bleeding with warfarin (monitor INR/PT). May the antiplatelet effects of clopidogrel

6. Claritin- antihistamines

Indications- Relief of symptoms of seasonal allergies. Management of chronic idiopathic urticaria. Management of hives Actions- Blocks peripheral effects of histamine released during allergic reactions Adverse Effects- NS: confusion, drowsiness (rare), paradoxical excitation. EENT: blurred vision. GI: dry mouth, GI upset. Derm: photosensitivity, rash. Metabolic: weight gain. Interactions- The following interactions may occur, but are less likely to occur with loratidine than with more sedating antihistamines. MAO inhibitors may intensify and prolong effects of antihistamines. CNS depression may occur with other CNS depressants , including alcohol , antidepressants , opioid analgesics , and sedative/hypnotics . Kava-kava , valerian , or chamomile can CNS depression 7. Januvia- antidiabetics Indications- Adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus; may be used as monotherapy or combination therapy with metformin and a thiazolidinedione and/or a sulfonylurea Actions- Inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which slows the inactivation of incretin hormones, resulting in increased levels of active incretin hormones. These hormones are released by the intestine throughout the day, and are involved in regulation of glucose homeostasis. Increased/prolonged incretin levels, increase insulin release and decrease glucagon levels Adverse Effects- CNS: headache. GI: PANCREATITIS, nausea, diarrhea. Resp: upper respiratory tract infection, nasopharyngitis. Misc: hypersensitivity reactions including anaphylaxis, angioedema, and exfoliative skin conditions (Stevens-Johnson syndrome), rash, urticaria. Interactions- May slightly serum digoxin levels; monitoring recommended

8. Novolin R- antidiabetics hormones(insulin) Indications- Control of hyperglycemia in patients with diabetes mellitus Actions- Lowers blood glucose by, stimulating glucose uptake in skeletal muscle and fat, nhibiting hepatic glucose production. inhibition of lipolysis and proteolysis. enhanced protein synthesis Adverse Effects- Endo: HYPOGLYCEMIA.Local: lipodystrophy, pruritus, erythema, swelling. Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS . Important- Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst) during therapy. Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine

9. Toprol-XL- antianginals, antihypertensives Indications- Hypertension, Angina pectoris, Prevention of MI and decreased mortality in patients with recent MI, Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be used with ACE inhibitors, diuretics and/or digoxin; Toprol XL only) Actions- Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine)-adrenergic receptor sites Adverse Effects- CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares. GU: erectile dysfunction. CV: BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction. Assessment- Monitor blood pressure, ECG, and pulse frequently during dose adjustment and periodically during therapy. Monitor frequency of prescription refills to determine compliance. Monitor vital signs and ECG every 515 min during and for several hours after parenteral administration. If heart rate <40 bpm, especially if cardiac output is also decreased, administer atropine 0.250.5 mg IV. Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of CHF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention) 10. Singulair- allergy, cold and cough remedies, bronchodilators Indications- Prevention and chronic treatment of asthma, Management of seasonal allergic rhinitis, Prevention of exercise-induced bronchoconstriction in patients 15 yr and older Actions- Antagonizes the effects of leukotrienes, which mediate the following. Airway edema. Smooth muscle constriction. Altered cellular activity. Result is decreased inflammatory process, which is part of asthma and allergic rhinitis

Adverse Effects- CNS: SUICIDAL THOUGHTS, agitation, aggression, anxiety, depression, dream abnormalities, fatigue, hallucinations, headache, insomnia, irritability, restlessness, tremor, weakness. Misc: EOSINOPHILIC CONDITIONS (INCLUDING CHURG-STRAUSS SYNDROME) , fever. 11. Lexapro- antidepressants Indications-Depression Actions- Selectively inhibits the reuptake of serotonin in the CNS Adverse Effects- CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, apathy, confusion, drowsiness, insomnia, weakness, agitation, amnesia, anxiety, libido, dizziness, fatigue, impaired concentration, depression, migraine headache. Misc: SEROTONIN SYNDROME, fever, yawning.

Interactions- May cause serious, potentially fatal reactions when used with MAO inhibitors ; allow at least 14 days between citalopram and MAO inhibitors. Concurrent use with pimozide may result in prolongation of the QTc interval and is contraindicated

12. ferrous sulfate- iron supplements; antianemics Indication- Treatment & prevention iron deficiency anemia Action- An essential mineral found in hemoglobin, myoglobin, and many enzymes, Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes part of iron stores Therapeutic Effect(s): Resolution or prevention of iron deficiency anemia Contradictions- Anemia not due to iron deficiency, Hemochromatosis, Hemosiderosis, Hypersensitivity to iron products Adverse effects- nausea, constipation, dark stools, epigastric pain Interactions- Iron absorption is 3350% by concurrent administration of food, Doses of ascorbic acid B200 mg may absorption of iron by up to 30% 13. Vasotec- antihypertensives- ACE Inhibitor Indications- Alone or with other agents in the management of hypertension. Management of symptomatic heart failure. Slowed progression of asymptomatic left ventricular dysfunction to overt heart failure Actions- Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also plasma renin levels and aldosterone levels. Net result is systemic vasodilation Adverse Effects- CNS: dizziness, fatigue, headache, vertigo, weakness. Resp: cough. CV: hypotension, chest pain. GI: abdominal pain, diarrhea, nausea, vomiting. GU: proteinuria, impaired renal function. Derm: rashes. F and E: hyperkalemia. Resp: dyspnea. Misc: ANGIOEDEMA.

14. Zithromax- agents atypical mycobacterium, anti-infectives Indications- reatment of the following infections due to susceptible organisms. Upper respiratory tract infections, including streptococcal pharyngitis, acute bacterial exacerbations of chronic bronchitis and tonsillitis. Lower respiratory tract infections, including bronchitis and pneumonia. Acute otitis media. Skin and skin structure infections. Nongonococcal urethritis, cervicitis, gonorrhea, and chancroid. Prevention of disseminated Mycobacterium avium complex (MAC) infection in patients with advanced HIV infection. Extended-release suspension (ZMax) Acute bacterial sinusitis and community-acquired pneumonia in adults Actions- Inhibits protein synthesis at the level of the 50S bacterial ribosome

Adverse Effects- GI: HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, cholestatic jaundice, liver enzymes, dyspepsia, flatulence, melena, oral candidiasis, pyloric stenosis. Derm: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, rashes. F and E: hyperkalemia. Misc: ANGIOEDEMA. Assessment- Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify health care professional immediately if these occur Assess patient for skin rash frequently during therapy. Discontinue azithromycin at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped Lab Test Considerations May cause serum bilirubin, AST, ALT, LDH, and alkaline phosphatase concentrations