Medications with Better Living Through Chemistry


Amoxicillin 

  • Antibiotic/Antimicrobial/Antibacterial
  • treats infections

Amoxicillin (plus Clarithromycin and protonpump inhibitor such as Omeprazol ([Prilosc]) 

  • given with pneumonia patients who has existing cardio pulmonary disease
  • high dose of amoxicillin/Clavulanate ([Augmentin, Clavulin]) plus a macrolide or doxycycline
  • a bacterial antibiotic that assists with eradicating H-Pylori bacteria in the gastric mucosa
  •  may cause diarrhea
  •  do not use in patients allergic to penicillin

Amoxicillin / Amoxil

  • first line of antibiotic for acute sinusitis

Clavulanate/Augmentin 

  • second line of antibiotic for acute sinusitis

Amoxicilliry/Clavinate (Augmentin) 

  • antimicrobial agents

Antideppressants

Sertraline/Zoloft

T-1/2 = 24 hours

Dosage: 50-200 mg/dc

Use: Depression, Panic Disorder, OCD, PTSD, Social Anxiety Disorder, PMDD

Side Effects: Drowsiness, dizziness, headache,fatigue,insomia,nausea,diarrhea, dry mouth, sexual dysfunctioning, sweating, tremor, myalgia, anxiety, altered taste, hot flashes, etc. 

Caution:Hepatic/ Renal Impairment/Pregnancy/Lactation/ Children

Serious Fatal Reaction with MAOI’s: concurrent primozide; do not use with St. John’s wort or SAMe; drug-drug interactions with drugs that inhibit the P-450 system. 

MAOI Diet (Tyramine) Restrictions

Foods must avoid completely

  • Aged red wines (cabernet sauvignon/merlot/Chianti)
  • Aged (smoked, aged, pickled, fermented, marinated, and processed) meats (pepperoni/bologna/salami, pickled herring, liver, frankfurters, bacon, ham)
  • Aged/mature cheeses (blue/cheddar/provolone/Brie/Romano/Parmesan/Swiss)
  • Overripe fruits and vegetables (overripe bananas/ sauerkraut/all overripe fruit)
  • Beans (fava/Italian/Chinese pea pod/fermented bean curd/soya sauce/miso soup)
  • Condiments (bouillon cubes/meat tenderizers/canned soups/gravy/sauces/soy sauce)
  • Soups (prepared/canned/frozen)
  • Beverages (beer/ales/vermouth/whiskey/liqueurs/canned soups/gravy/sauces/soy sauce)

Foods use with caution moderation

  • Avocados (not overripe)
  • Raspberries (small amounts)
  • Chocolate (small amounts)
  • Caffeine (2-8 oz. Servings per day or less)
  • Dairy products (limit to buttermilk, yogurt, and sour cream [small amounts]; cream cheese, cottage cheese, milk ok if fresh)

Medications: Must Avoid

  • stimulants and decongestants
  • OTC medications (check with PCP/pharmacist) 
  • Opioids (e.g. meperidine)

Biguanides

Metformin (Glucophage)

  • oral antidiabetic agents
  • produces it’s antidiabetic effects by facilitating insulin’s action on peripheral receptor sites
  • it can be used only in the process of insulin
  • have no effect on pancreatic beta cells
  • used with a sulfonyl urea 
  • may enhance the glucose -lowering effect more than either medications used alone.

Complication: Lactic Acidosis (Monitor closely when therapy is initiated/dosage change

Drug Interactions: 

  • Anticoagulants
  • Corticosteroids
  • Diuretics
  • Oral Contraceptives 

Contraindications

  • renal impairment serum creatinine level more than 1.4
  • risk for renal dysfunction (e.g. Acute Myocardial  Infarction

Renal function studies performed periodically to ensure that function is not impaired. 

Withold for two days prior to diagnostic testing that requires contrast agent. Increase risk for lactic acidosis. An extended release form and a combination form (Glucovance) combines Metformin with a Sulfonylurea such as glyburide. The combination provides two mechanism of action and improved potential compliance. Hypoglycemia is at risk.

Anticonvulsants

Carbamazepine (CBZ) / Tegretol

T1/2 = initial: 18-55 h;

long-term 

dosing: 12-17 h 

Dosage: 400-1200 mg/d (mania)

Use: Bipolar: Acute Mania; mixed; seizures, trigeminal pain

Common Side Effects: Ataxia, drowsiness, blurred vision, APLASTIC ANEMIA, AGRANULOCYTOSIS, THROMBOCYTOPENIA, STEVENS-JOHNSON SYNDROME (SJS) 

CAUTION : Therapeutic Range (4-12ug/mL) Weekly CBC, platelet and reticulocyte counts, LFTs; impaired renal/liver/cardiac functions. Sx of SJS: cough, FUO, mucosal lesions, rash; stop CBZ.

Chantix/ Varenicline

– treats nicotine addiction

Side Effects: Constipation give enema as prescribe 


Antiviral Drug

Valtrex (Valacyclovir)

Treatment: herpes virus, genital herpes, cold sores, shingles

Side effects: nausea, vomiting, diarrhea and headache

Opiods:

Oxycodone

orally- provides a consistent serum level than IM

Dosage: 20 to 30 mg 

T1/2: 2-3 hours

Duration 2-4 hours

Side effects:

  • Respiratory deppression – increase risk with age and with other depressants
  • sedation- opioid doses are increase; increase the time of dose and reduce dose temporarily as prescribe
  • Nausea and vomiting – appears after a few hours of ingestion; change position slowly; hydrate and give antiemetic drugs as prescribe
  • Constipation – mild laxative; fluid; fiber; 
  • Check for liver toxicity

 Antianxiety (Anxiolytic drugs)

Benzodiazepines

Alprazolam/ Xanax

Use: Anxiety, panic disorde

Dosage: 0.75-4 mg/d; not to exceed 10 mg/d

Common Side effects: Dizziness, drowsiness, lethargy, headahe, blurred vision, constipation, diarrhea. Possible physical/psychological dependence,tolerance, paradoxical excitation

Caution:  Hepatic dysfunction

Contraindications: pregnancy/lactation; narrow-angle glaucoma; concurrent ketoconazole or itraconazole; decrease dose elderly/debilitated

Attention Deficit Hyperdisorder (ADHD) 

Amphetamine/ Adderall 

Dosage: 5-40 mg/ 10-30 mg

Use: focus

Cardiovascular Drugs

Angiotensin Converting Enzyme Inhibitors

Benazepril (Lotensin)/Captopril (Capoten)

  • Inhibits conversion of angiotensin I to angiotensin Ii
  • Lowers total peripheral resistance
  • Fewer cardiovascular side effects
  • Can be used with thiazide diuretics and digitalis
  • Hypotension can be reversed by fluid replacement
  • Contraindicated with renal impairment/pregnancy
  • Gerontologic considerations: requires reduce dosage and the addition of loop diuretics when there is a renal dysfunction


Angiotensin II Receptor Blockers

Losartan (Cozaar)/Eprosartan (Teveten)

  • Block the effects of angiotensin II at the receptor
  • Treats hypertension
  • Reduce peripheral resistance
  • Minimal side effects
  • Contraindicated: pregnancy, renovascular disease
  • Monitor for hypokalemia


Antilipidemics

Lipitor (Atorvastatin)

Dose: Given once daily, usually in the evening

  • Statins inhibit an enzyme involved in cholesterol synthesis, especially in the liver.
  • Increase serum high density lipid (HDL)
  • Decrease low density lipid (LDL)  and very low density lipid (VLDL) and plasma + triglyceride levels
  • Nursing implications: contraindicated to pregnancy
  • May cause multiple gi symptoms
  • Increased liver function test
  • Increased digoxin and oal contraceptive levels
  • May cause rhabdomyolysis
  • Discontinue at first sign of pain


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