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Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Aripiprazole (not available)
- Brand: Abilify®
- Mechanism of Action
- Atypical Antipsychotic
- Its exact mechanism is unknown, but it is known to be a partial agonist of dopamine D2 and serotonin 5-HT1A receptors and an antagonist of 5-HT2A receptors
- Indications read more…
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Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Tiotropium (not available)
- Brand: Spiriva® Handihaler®
- Mechanism of Action
- Long acting anticholinergic
- Causes bronchodilation by inhibiting the action of acetylcholine at muscarinic type 3 receptors
- Indication
- COPD
- Specifically chronic management of COPD
- COPD
- Dosage form
- Capsule
- 18 mcg powder for inhalation
- Capsule
- Adult Dosing
- COPD
- One capsule once/day
- COPD
- Pharmacokinetics
- Minimally metabolized in the liver by CYP2D6 and 3A4
- Onset of action ~30 minutes
- Peak effect ~3 hours
- Duration ~24 hours
- Contraindication
- Hypersensitivity
- Precautions
- Although rare, paradoxical bronchospasms can occur
- Discontinue use if this is an issue
- Tiotropium can potentially worsen narrow angle glaucoma, myasthenia gravis, and prostatic hyperplasia
- Use with caution in these patient populations
- Capsules contain lactose
- Use with caution in patients with a severe milk protein allergy
- Although rare, paradoxical bronchospasms can occur
- Adverse Drug Reactions
- Most common
- Xerostomia (dry mouth)
- Upper respiratory tract infection
- Pharyngitis
- Sinusitis
- Most common
- MAJOR Drug Interactions
- Tiotropium can have additive effects when used with other anticholinergic drugs
- Use with acetylcholinesterase inhibitors (such as physostigmine and donepezil) can decrease the effects of both medications
- Pregnancy Category/Breast feeding
- Category C
- Use with caution in breastfeeding
- Safety and Efficacy Monitoring
- FEV1
- Peak Flow
- Major Counseling Points
- Take each dose at the same time everyday
- Spiriva should not be used for current bronchospasm
- Does not act fast enough
- Short acting “rescue” inhaler should be used
- Capsules should only be inhaled using the HandiHaler inhaler and should not be swallowed
- How to use the HandiHaler:
- http://www.spiriva.com/consumer/taking-spiriva/how-to-take-spiriva.jsp
- Remove capsule from the foil blister pack right before use
- Open the dust cap and mouthpiece and place capsule in the chamber at the base of the inhaler
- Close the mouthpiece (should hear a click when closed)
- Hold the inhaler so the mouthpiece is facing upwards and depress the green piercing button one time (this punctures the capsule)
- Exhale fully (not into the inhaler)
- Place your lips around the mouth piece and inhale slowly and deeply
- Should hear and/or feel the capsule vibrating
- Hold you breath as long as possible (at least 5-10 seconds)
- Repeat the inhalation at least one time until no powder remains in the capsule
- Discard the used capsule after use
- The most common side effect is dry mouth
- Let you doctor or pharmacist know if you experience any severe or persistent side effects
References:
- Tiotropium. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 25]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline
- Spiriva. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17
- How to take SPIRIVA. Boehringer Ingelheim Pharmaceuticals, Inc [Internet]. 2010 [Cited 2010 Aug 25]. Available from: http://www.spiriva.com/consumer/taking-spiriva/how-to-take-spiriva.jsp
- Spiriva HandiHaler. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 25]. [About 5 p.]. Available from: https://online.epocrates.com/noFrame/
- 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
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Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Oseltamivir (NOT available)
- Brand: Tamiflu®
- Mechanism of Action
- Antiviral
- Prodrug
- Hydrolyzed in the liver to its active form, oseltamivir carboxylate
- Oseltamivir carboxylate blocks the release of the influenza virus from host cells by inhibiting influenza virus’ enzyme, neuraminidase
- Indications read more…
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Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Conjugated estrogens (not available)
- Brand: Premarin
- Mechanism of Action
- Premarin contains a mixture of different estrogens, which control the development and function of the female reproductive system as well as the development of secondary sexual characteristics (i.e. breast enlargement, fat deposition, etc.)
- Estrogens affect the secretion of gonadotropins, FSH, and LH thru negative feedback on the pituitary gland.
- So, for postmenopausal females, levels of these hormones are reduced which improves postmenopausal symptoms
- Indications read more…
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090 Amlodipine/Benazepril (Lotrel®)
Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Amlodipine and Benazepril
- Brand: Lotrel®
- Mechanism of Action
- Amlodipine:
- DHP Calcium channel blocker
- Causes relaxation of vascular smooth muscle and cardiac muscle by Inhibiting calcium influx
- Works more in the vasculature (as do all DHP CCBs) than in the cardiac muscle
- Non-DHP CCBs (Verapamil and Ditiazem work more in cardiac muscle)
- Benazepril:
- Angiotensin Converting Enzyme Inhibitor (ACE-I)
- ACE normally converts angiotensin I to angiotensin II, which acts as a potent vasoconstrictor and causes the release of aldosterone (which increases sodium and water reabsorption)
- ACE-Is blocks this conversion which leads to a reduction in angiotensin II and reduced aldosterone secretion
- So overall, benazepril and amlodipine work together to decrease blood pressure
- Amlodipine:
- Indication read more…
Sorry. No post/episode today. I went whitewater rafting with good friends over the weekend (one of which is getting married in two weeks) and didn’t have time to put out an episode today. New post/episode will be up tonight. Please contact me if you have any questions, comments, or suggestions! Thanks for stopping by!
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Note: 087 and 088 (metformin and toprol-XL) have been covered in previous episodes
Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Pantoprazole (available as delayed release tablets)
- Brand: Protonix®
- Mechanism of Action
- Proton pump inhibitor (PPI)
- Inhibits H/K-ATPase in gastric parietal cells which suppresses gastric acid secretion
- Indications read more…
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Note: 083, 084, and 085, drugs (Alprazolam, Albuterol, Atenolol) have been covered in previous episodes
Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Lorazepam (available)
- Brand: Ativan®
- Mechanism of Action
- Benzodiazepine (C-IV)
- Binds benzodiazepine receptors in the CNS, increasing the effect of GABA
- GABA is an inhibitory neurotransmitter and works by hyperpolarizing neuronal cells which makes them less excitable
- Indications read more…
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Note: 080 and 081 most prescribed drugs, warfarin and lisinopril, have been covered in previous episodes
Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Valacylcovir (available)
- Brand: Valtrex®
- Mechanism of Action
- Valacyclovir is converted to acyclovir in the intestines and liver, which is eventually converted to acyclovir triphosphate
- Acyclovir triphosphate Inhibits DNA polymerase and is incorporated into viral DNA itself
- Results in inhibition of viral DNA synthesis and viral replication
- Indications read more…
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079 Propoxyphene & Acetaminophen
Episode Notes (References Below)
- Brand/Generic Available?
- Generic: Propoxyphene and Acetaminophen (available)
- Brands:
- Darvocet® (propoxyphene napsylate and acetaminophen)
- Mechanism of Action
- APAP
- Analgesic and antipyretic
- Inhibits prostaglandin synthesis in the CNS, which gives it its analgesic properties
- Inhibits the hypothalamic heat-regulation center, which gives it its antipyretic properties
- Propoxyphene
- Binds mu and kappa opioid receptors within the neuronal membranes of synapses which blocks pain perception in the cerebral cortex
- APAP
- Indication read more…
