Generic/Brand & Drug Class
Sitagliptin
Januvia -- DPP-4 inhibitor (Dipeptidyl peptidase-4 inhibitor)
1) ear, nose & throat infection, 2) community acquired pneumonia, 3)skin and skin structure infection, 4) STI, 5) mycobacterium avian complex in HIV (prophylactic treatment)
^ The following disease states are all covered by which BIG GUN, broad class, antibiotic? Provide generic/brand name of drug and specific drug class.
Azithromycin (Zithromax, Z-pak)
Drug class - macrolide
(Bonus: is this a beta lactam antibiotic, or no?)
What are two counseling points for a patient started on metronidazole?
1) Avoid alcohol during therapy after for 72 hours after.
2) Taste disturbances (metallic)
Name the 3 big counseling points for antibiotics, that Dr. Rebitch said we need to know.
1) FINISH YOUR ANTIBIOTICS COURSE!
2) GI (DIARRHEA/CRAMPING/NAUSEA) ARE COMMON SIDE EFFECTS, SO COUNSEL PT TO TAKE WITH FOOD!
3) RECOGNIZE HYPERSENSITIVITY/ALLERGY (RASH) vs. INTOLERANCE (diarrhea)
What are 1st line drug classes used to treat hypertension?
Dihydropyridine calcium channel blockers, ACEi, ARB, thiazide diuretic
*Bonus: name one side effect of CCBs
Flagyl
Metronidazole -- antibiotic
For a patient with a history of type 2 diabetes, heart failure and chronic kidney disease, what drug would you recommend initiating for A1c lowering purposes?
jardiance - empagliflozin - SGLT2i
Grandpa Bob has never liked taking medications. He chooses to take them when he feels like it and if he thinks he needs it. He was recently started on cleocin for management of a skin infection. How would you counsel Gramps about this medication?
Clindamycin (cleocin) is not long acting, and can be dosed up to 4 times/day. Dig into hx of medication noncompliance and come up with ways to improve Grandpa Bob's adherence.
Travis Kelce was started on metformin 3 weeks ago and reports he has felt unwell as of late. What are common side effects seen with metformin?
GI upset (diarrhea/cramping) is very common and dose of metformin will likely need to be titrated.
A rare but serious side effect is LACTIC ACIDOSIS!
Name the 1st line drug used to treat hyperlipidemia and provide secondary prevention for CVD.
Lipitor or atorvastatin -- an HMG-CoA reductase inhibitor.
Cipro
Ciprofloxacin - Fluoroquinolone (BIG GUN drug)
Harley Quinn recently returned from travel, and has been experiencing symptoms consistent with a tick bite. For prophylaxis and prevention of Lyme's disease, which drug should be prescribed?
Doxycycline (vibramycin) - tetracycline
Treats Lyme's disease + dermatologic conditions (acne, rosacea)
What are two counseling points for a patient started on doxycycline?
1) Take with a full glass of water, 2) Remain upright after use, to avoid esophageal irritation.
(BONUS: Name another drug, where it is advised to remain upright? Which disease state does this drug address?)
What are two counseling points for a patient started on a sulfonylurea?
1) Take with food to avoid risk of hypoglycemia (glucose independent)
2) Possible weight gain?
3) Plateau effect... not a long-term drug
What are some side effects of beta blockers?
Fatigue, bradycardia, blunted exercise response, sexual dysfunction, cold extremities, hypotension. *Caution use in pts with hx of DM & respiratory disease.
Apidra
Generic: glulisine
Type: prandial (bolus) insulin
PK: Fast acting! 5-10 minutes before food
Metro Boomin has history of T1DM and has been managed on lantus (insulin glargine) thus far. However, his blood sugars and A1c have been increased over the past 6 months. Metro's endocrinologist, suggested he compliment his current antidiabetic regimen with a fast-acting insulin. What are examples of fasting-acting insulins?
1. Insulin aspart - Novolog
2. Insulin lispro - Humalog
3. Insulin glulisine - Apidra
What are some counseling points for a patient started on pioglitazone?
1) Can cause weight gain (in the form of edema AKA fluid build edema) and should be avoided in patients with symptomatic heart failure.
2) Avoid in patients with elevated liver enzymes.
3) Takes up to 6 weeks for maximal effects.
4) May improve lipid panel, particularly triglycerides and HDL.
Kylie Jenner's 2 year old son was recently started on pioglitazone for pediatric blood sugar management. Is this appropriate?
NO! COUNSELING POINT - only for 10 and up!
What is the brand name and drug class of clopidogrel?
Plavix, P2Y12 inhibitor
* Bonus: Name a drug that should not be concomitantly used with plavix. Describe why?
Bactrim
Sulfamethoxazole/trimethoprim -- sulfa antibiotic
Albus Dumbledore was recently started on Keflex and presents to the pharmacy to pick up his prescription. During his encounter with the pharmacist, he reports a history of anaphylaxis on amoxicillin. In this case, would it be safe to proceed therapy with Keflex?
NO!!! Cephalosporins have cross-reactivity with penicillin drugs, and should be avoided if pt has hx of IgE mediated or Type 1 response, such as anaphylaxis. However, if Mr. Dumbledore only experienced a rash (delayed drug reaction), it would be okay to proceed with Keflex or cefdinir.
Michael Scott has an unfortunate case of Traveler's diarrhea and Bactrim is being considered for treatment. Of note, he does have a past medical history significant for atrial fibrillation and is on Warfarin. What is the drug therapy problem at hand and why?
Bactrim has a drug-drug interaction with warfarin and should be avoided if possible, as Michael's INR can increase (therapeutic range is 2-3), further elevating his risk of bleed. If there are no alternative antibiotics, Michael may proceed with both Bactrim and Warfarin, but should be heavily monitored.
Metro Boomin is back at his community pharmacy. During his annual exam with his primary care provider, he was found to have oropharyngeal candidiasis (yikes!) and was told to start fluconazole. However, Metro is also on a statin to lower his cholesterol. His PCP advised him to discuss whether it would be okay to take both medications with his pharmacist. Frustrated and confused, Metro demands answers and wants to know if he can start fluconazole to clear up his oropharyngeal candidiasis. What is the drug therapy problem at hand?
Counsel Metro on the drug interactions with fluconazole. Fluconazole is a CYP inhibitor and can interact with drugs metabolized via CYP3A4 enzyme (aka statins and calcium channel blockers). This can increase absorption, resulting in lethal concentrations of other drugs.
Fill in the blanks.
---- is a loop diuretic and ------ is a thiazide diuretic. Both drugs can cause metabolic disturbances, such as hypo--------.
LASIX (furosemide) is a loop diuretic and HYDROCHLOROTHIAZIDE (oretic, microzide) is a thiazide diuretic. Both drugs can cause metabolic disturbances, such as HYPOKALEMIA.