Walmart $4 drug list + from clinic – Flashcards

Antihypertensive Loop Diuretic; acts on the co-transporter in the thick ascending portion of the loop of Henle Competitive inhibitor of the co-trasporter, which prevents reabsorption of Na+, Because the Na+ is not being reabsorbed into the blood; water is not "following" the Na+ into the blood there by decreasing the total blood volume which causes a decrease in blood pressure. 95% plasma protein-bound FDA-approved uses Edema Hypercalcemia HTN HTN emergency HTN urgency Nephrotic syndrome Pulmonary Edema Renal impairment Non-FDA approved (off-label) uses Ascites Adverse effects: Hypokalemia, hypocalcemia, and hyponatremia Dehydration and Acute Hypovolemia Hyperglycemia, hyperuricemia Ototoxicity: this vs other $4 drug in same category when treating just HTN, use one of the other drugs, use this to treat edema it is the best from the $4 list

Class:Water Soluble B-Complex Vitamin Mechanism of Action: important in DNA/RNA synthesis & maintenance in erythropoesis. FDA Approved Use: Megaloblastic & Microcytic anemia due to folate deficiency as well as a dietary supplement to prevent Neural Tube defects. Adverse effects: Slight flushing Warnings: Not appropriate for monotherapy with pernicious, a plastic, or normocytic anemia with VB12 deficiency Pregnancy Category: A

Drug Class: Parkinson Disease/Dystonia MOA: Benztropine is an antimusclarinic agent that in theory should lead to better balance between loss of dopamine & increase acteylcholine activity. In reality are mainly effective against tremors. It works by antagonizing acetylcholine & histamine receptors. FDA approved Uses: Adult - extrapyramidial symptoms, acute dystonic reactions; Peds - extrapyramidal symptoms Non-FDA approved: peds - parkinson disease Adverse Effects: xerosomia, constipation, urinary retention Other in same category: Trihexyphenidyl When to use other drugs: Trihexyphenidyl is first line option for refractory tremors in parkinson patients.

Category: Antibiotic (Penicillin) Class: Cell Wall Synthesis Inhibitor (Beta Lactam Drugs) MOA: Bactericidal abx that kills bacteria by inhibiting the cel wall synthesis FDA Use: Bacterial infxn- strep pharyngitis, AOM, CAP, bacterial sinusitis, and combo H. pylori Adverse Effects: Diarrhea, N/V, hypersensitivity (rash to anaphylaxis) Warnings: Pt with a hx of penicillin or beta-lactam hypersensitivity and asthmatics should use medication with caution. Pt with mononucleosis often develop a rash. DON'T Rx amoxicillin with mono! $4 List: Penicillin VK is a 1st generation penicillin, PO, and is also DOC for strep throat. Amoxicillin is a 3rd generation penicillin -> broader spectrum abx

Category: Drug for Osteoporosis Class: Bisphosphonates Half-life: Terminal half-life of over 10 years, reflecting it's release from the skeleton. Terminal plasma half-life is the time required to divide the plasma concentra-tion by two after reaching pseudo-equilibrium, and not the time required to eliminate half the administered dose. FDA-approved uses:Prevention of post-menopausal osteoporosis, Treatment of post-menopausal osteoporosis, Treatment of glucocorticoid-induced osteoporosis, Tretment of osteoporosis in men, Paget's disease. Long term studies with Alendronate suggest that it is safe to use for treatement for up to 10 years Adverse effects: According to Tarascon, esophageal and gastric mucus membrane irritation that may be mild to severe: esophagitis, esophageal ulcers, esophageal erosions, occasionally bleeding, or rarely stricture, perforation. Warnings/ Precautions/ Contraindications: Because of Esophageal and gastric mucus membrane irritation , tablets should be swallowed with water (approx 250 mL) and pt should be kept sitting upright for ~30 mins after drug administration. May want to discontinue use if the patient requires invasive dental procedures as the discontinuation may reduce the risk of osteonecrosis of the jaw.

Pharmacologic category: Antihypertensive Drug class: Thiazide Diuretic MOA: Reduces preload and afterload Vasodilatory effects Inhibit NaCl reabsorption in distal convoluted tubule Increase excretion of NaCl and H2O FDA-approved uses: HTN & Edema in adults, Edema in peds Non-FDA approved (off-label) uses: Nephrolithiasis Adverse effects: Hypokalemia (70% of pts), Hyperuricemia (70% of pts), Hyperglycemia: Decreases insulin sensitivity in 10% of patients- avoid in diabetics, Hyperlipidemia/dyslipidemia: Can raise LDL and lower HDL

Class: dopamine D2 antagonist MOA: selectively antagonizes dopamine D2 receptors FDA uses: Tourette's syndromes, psychotic disorder, schizophrenia Off-label: acute psychosis and combative behavior. NOT approved but commonly used IV for acute psychosis, delirium (especially in acute manic episodes of delirium seen in bipolar disorder ) and acute agitation. Adverse effects: BBW-not approved for dementia related psychosis Extrapyramidal symptoms (EPS) including; dystonias, akathisia, Parkinson like symptoms, tardive dyskinesia QT prolongation Neuroleptic Malignant Syndrome (NMS) Contraindications: Parkinsons Considerations when choose other drugs in same category on $4 list: Fluphenazine is also on list and I would choose this over Haloperidol as an antipsychotic if the pt has a history or risk for QT prolongation. Unlike Haloperidol, Fluphenazine does not cause QT prolongation so it would be a better choice fo rpt at risk or if pt was taking other meds that cause QT prolongation.

Thyroid Agent; Thyroid Replacement (synthetic T4) Identical to T4 produced by thyroid gland Increases metabolism and produces other various physiological effects Taken on empty stomach, 30+ min prior to eating; Same time daily FDA: hypothyroidism Non-FDA: depression, when combo'd w/ antidepressants ADVERSE: palpitations, tachycardia, nervousness, diarrhea, insomnia WARNINGS: contradicted or used cautiously in pts w/ hx of...acute MI, CVD, DM, elderly, anemia PREGNANCY A SAME CATAGORY/NOT ON LIST: Armour Thyroid (porcine thyroid)...consider use in pts w/ decreased liver funx bc primarily metabolized in tissue & only minimally metabolized in liver

Drug class: centrally acting skeletal muscle relaxant MOA: reduces tonic somatic motor activity Distribution: highly bound to proteins (93%) FDA approved uses: skeletal muscle spasm associated with acute, painful musculoskeletal conditions. non FDA uses: fibromyalgia Adverse effects: solmnolence Warnings/Precautions: do not use with CNS depressants (risk of additive effects); also do not use long term (short-term use only- 2-3 weeks)

Pharmacologic Category: Antihypertensive Drug Class: ACE Inhibitor MOA: Inhibits angiotensin converting enzyme FDA Approved Uses: HTN, CHF, Diabetic Nephropathy, Acute MI Adverse Effects: Cough Considerations in choosing between this drug and others in the same category on the $4 list: Lisinopril, Enalapril, Benazepril, are only taken once daily, which would help with patient compliance (Captopril is taken twice daily).

Pharmacologic category: Steroidal antiinflammatory, anti-pruritic, immunosuppressant Drug class: High potency synthetic topical corticosteroid MOA: Triamcinolone suppresses migration of polymorphonuclear leukocytes and reverses increased caplillary permeability thus resulting in decreased inflammation. It also suppresses the immune system by reducing the lymphatic system's activity and volume. Pharmacokinetics and pharmacodynamics: The common route of administration is topical. It is minimally absorbed by normal skin. However, absorption is increased in inflamed skin and exfoliative diseases. Occlusion therapy (plastic dressing, shower cap, etc) increases potency 10-100 fold. Ointments are more effective than creams and lotions, but ointments are messier. FDA-approved uses Oral/topical: Adjunctive treatment and temporary relief of symptoms associated with oral inflammatory lesions and ulcerative lesions resulting from trauma, inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Adverse effects: Burning, Itching, Irritation, Dryness, Folliculitis Severe Effects: HPA axis suppression Considerations in choosing between the other drugs in same category on $4 list Triamcinolone 0.5% cream is high potency compared to Hydrocortisone 1% cream which is low dose and OTC. Hydrocortisone is used for dermatosis as well as external anal/genital itching. High potency creams should not be used on the face or genitals. When there is anal/gentital itching, hydrocortisone 1% is preferred over triamcinolone 0.5%.

Drug Class: Tetracycline MOA: Doxycycline is a reversible inhibitor of protein synthesis, Do not give with foods or medicines that contain calcium, iron, or magnesium. Do not give with antacid or iron-containing medicines or supplements. FDA approved: infections with gram-positive and gram-negative bacteria, Mycoplasma pneumoniae, Chlamydia Adverse Effects: General: nausea (on empty stomach), inhibition of bone growth (fetus, infants and children), discoloration of teeth and bone growth retardation, photosensitivity Warnings/Precautions/Contraindications: Photosensitivity, Advise patients to avoid exposure to sunlight or tanning beds and wear protective clothing and sunscreen SPF 30 or higher outdoors. Teeth discoloration, avoid in children under age 8. Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old. Doxycycline can make birth control pills less effective. Ask your patients about using a non hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while using doxycycline . Nursing mother recommendations. Doxycycline is excreted in milk and may affect bone and tooth development in a nursing baby. Avoid in lactation

Category: Antidepressant Class: TCA MOA: Primarily inhibits serotonin reuptake at neuronal membranes, inhibits norepinephrine reuptake after metabolism FDA-approved uses: depression; adults and children >12yo Non-FDA approved uses: migraine prophylaxis, chronic neuropathic pain, post-herpetic neuralgia, fibromyalgia Most common adverse effect: dry mouth, drowsiness, dizziness, weight gain, increased appetite Black Box Warning: suicidality Considerations: within the antidepressant pharmacologic category SSRIs are considered first line treatment for depression due to the effectiveness and amount of adverse effects. SSRIs should be considered before second line TCA medications for the treatment of depression

Pharm category: Antihypertensive Drug class: ACE Inhibitor MOA: Inhibits ACE in the lungs Reduces the activity of the renin-angiotensis-aldosterone system Interferes with conversion of angiotensin I to angiotensin II Inhibits inactivation of bradykinin Lowers BP by lowering Peripheral Vascular Resistance Does not undergo metabolism; excreted unchanged in urine kidneys. Contraindicated: Potassium sparing diuretics FDA Approved Uses: HTN, Heart Failure Improves survival after acute MI Non-FDA approved uses: Prevent kidney failure due to high BP or diabetes Adverse effects: Increased bradykinin effects: dry cough, rash, taste disturbances, angioedema Hyperkalemia Other $4 drug in same category: Captopril Enalapril Reasons to recommend other drugs not on $4 list over this drug: If the patient has liver complications, I would recommend Lisinopril over since it does not undergo metabolism.

Drug class: Selective Serotonin Reuptake Inhibitor MOA: Selectively inhibits serotonin reuptake Pharmacokinetics and Pharmacodynamics: drinking alcohol can increase certain side effects of fluoxetine FDA approved use: major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, panic disorder, premenstrual dysphoric disorder, bipolar I disorder-acute depressive Non-FDA approved uses: hot flashes, post traumatic stress disorder, social anxiety disorder Adverse effects: nausea Warnings: black box warning- increase suicidality risk in children, adolescents and young adults with major depressive or other psychiatric disorders, avoid abrupt withdrawal $4 list: fluoxetine is the only SSRI on the $4 list that is approved for children

Category: Antihyperglycemic Class: Biguanide MOA: Decreases hepatic glucose production and intestinal gluvose abroption; increases insulin sensitivity; doe NOT stimulate insuline release PK/PD: Alcohol increases risk of lactic acidosis while taking metformin FDA-approved uses: Treatment of Type 2 DM in adults and children over 10yo Non-FDA-approved uses: PCOS and prevention/delay of DM type 2 in pts with glucose intolerance Adverse Effects: GI distress Lactic acidosis (esp in pts with cardiac/respiratory, renal, or hepatic disease and chronic alcoholics) Vitamin B12 (may require B12 supplementation) Warnings: stop med before and for 48hrs after contrast studies and surgery Consideration for different $4 drug: A sulfonylurea may be chosen as monotherapy if pt is unable to tolerate metformin.

Pharm Category: Anti-Anginal Drug Class: Cardiovascular, Sub Class: Vasodilators/Nitrates MOA: Stimulates cGMP production resulting in vascular smooth muscle relaxation FDA-Approved Uses: Angina prophylaxis

Category: Antihypertensive Drug class: alpha-2-agonists MOA: direct stimulation of CNS alpha-2-adrenergic receptors to decrease sympathetic outflow which will decrease BP and HR FDA approved uses: HTN Non-FDA uses: nicotine withdrawal Children: ADHD Adverse effects: sedation, dry mouth, postural hypotension, drinking increases these effects; must taper off due to withdrawal effects Other drugs in category: Methyldopa Why use it: methyldopa is for pregnancy; clonidine is for HTN refractory to 2 other agents

Pharmacologic Category: Bladder agent Drug Class: Anticholinergic and combinations MOA: Antagonizes acetylcholine at muscarinic receptors; relaxes bladder smooth muscle, inhibits involuntary detrusor muscle contractions FDA approved uses: Adults overactive bladder (bladder instability) Non FDA approved uses: Hyperhidrosis (excessive sweating) Adverse Effects: Dizziness, drowsiness, blurred vision, dry mouth, urinary retention, and obstructive GU and GI disease.

Pharmacologic Category: Antihypertensive & BPH Drug Class: Alpha 1 Blocker MOA: HTN- Competitively inhibits postsynaptic alpha 1 adrenergic receptors which results in vasodilation of veins and arterioles and a decrease in total peripheral resistance and blood pressure BPH- Competitively inhibits postsynaptic alpha 1 adrenergic receptors in prostatic stromal and bladder neck tissues. This reduces the sympathetic tone-induced urethral stricture causing BPH sxs FDA Approved Uses: Treatment of HTN as monotherapy or in conjuction with diuretics, ACE inhibitors, beta blockers, or calcium antagonists. It is also used in the treatment of urinary outflow obstruction and/or obstructive and irritative sxs associated with BPH. Warnings/Contraindications: Can cause significant orthostatic hypotension and syncope, especially with first dose. Anticipate a similar effect if therapy is interrupted for a few days, if dosage is rapidly increased, or if another antihypertensive drug (particularly vasodilators) or a PDE-5 inhibitor is introduced. Considerations in choosing between this drug and others in the same category on $4 list: Doxazosin and Terazosin are first line drugs used to treat BPH, effective within days. They are second line agents used in treatment of hypertension. Most useful in patients with HTN + BPH. First dose hypotension occurs less frequently with doxazosin as compared to prazosin.

Category: Antihypertensive Class: Cardioselective beta blocker MOA: beta adrenergic receptor antagonist with decrease in CO by decreasing HR and contractility FDA approved Uses: HTN, acute MI, post MI prevention, CHF, rate control on SVT, A fib, A flutter and angina Non FDA approved uses: migraine and thyrotoxicosis Adverse Effects: fatigue, sexual dysfunction, asthma exaccerbation (even though a cardioselective agent, still caution especially with increasing doses)

Pharm Category: Gastrointestinal Drug Class: H2 Blocker MOA: Selectively antagonizes Histamine H2 receptors. Prevents histamine induced H+ secretion FDA approved Uses: GERD, Doudenal Ulcer (active & maintenance tx), Gastric Ulcer (active and maintenance tx), Esophagitis (erosive), Hypersecretory Conditions, Dyspepsia, H. Pylori Infection, Zollinger-Ellison Syndrome. Non-FDA approved Uses (off label): Allergic Reactions (disputed) Pregnancy Category: B Considerations: Ranitidine has less adverse effects than Cimetidine, Famotidine, and Promethazine. Ranitidine is also a Pregnancy category B and considered Safe in Lactation unlike Promethazine and Belladonna Alkaloid

Pharm category: Analgesic: Skeletal Muscle Relaxant Drug class: Antispasmodic Pharmacokinetics & Dynamics: drinking alcohol can increase certain side effects of Baclofen FDA Approved Uses: adults approved for spasticity related to MS or spinal cord disease/injury Non-FDA approved uses: trigeminal neuralgia, tardive dyskinesia, intractable hiccups Adverse Effects: CNS depression & drowsiness Warnings: drowsiness and or sedation may be enhanced with alcohol or other CNS depressants. Hallucinations and seizures with abrupt withdrawal Other $4 drugs in same category: Cyclobenzaprine Considerations in choosing between this drug and others in same category on $4 list: cyclobenzaprine is Pregnancy Category B so it's safer than Baclofen, which is Category C. Cyclobenzaprine is used primarily for musculoskeletal pain

Pharmacologic Class: Antiviral MOA: inhibit viral DNA polymerase; incorporates into viral DNA FDA-approved uses: HSV I and II- genital herpes and oral herpes, Varicella Zoster Virus- Herpes Zoster, Chickenpox Non-FDA approved uses: infectious mononucleosis Warnings: Caution in renal impairment Other drugs in same category NOT on $4 list: Famciclovir and Valacyclovir

Pharm. Cat: Antifungal MOA: binds to cell membrane sterols and increases permeability FDA Approved uses: oral candidiasis, intestinal candidiasis, topical candidiasis, vaginal candidiasis Considerations: type of preparation depends on what type of candidiasis you have Special Considerations: fluconazole is recommended for vaginal candidiasis over nystatin, terbinafine is preferred for nail fungus and tinia infections

Pharmacologic category: Antibiotic Drug Class: Folate Antagonist (Antimetabolite) MOA: Sulfamethoxazole interferes with bacterial folic acid synthesis and growth via inhibition of dihydrofolic acid formation from para-aminobenzoic acid; trimethoprim inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in sequential inhibition of enzymes of the folic acid pathway. FDA-approved Uses: Chronic bronchitis, Shigellosis, Travelers' diarrhea, UTI Non-FDA-approved Uses: Skin/soft tissue infection due to community-acquired MRSA Warnings: Contraindications: Hypersensitivity to any sulfa drug Special Considerations in Choosing between Different Preparations: Use tablets more most adults. Use suspensions for kids and those that have a hard time swallowing pills Considerations in choosing between this drug and others in same category on $4 list: For UTI, if there is known or suspected antibiotic resistance, then use Ciprofloxacin.

Drug class: Macrolide MOA: inhibits bacterial protein synthesis by binding reversibly to 50S ribosomal subunits (bacteriostatic) FDA-approved uses: Adults: superficial ocular infections involving the conjunctiva/cornea; Peds: opthalmia neonatorum prophylaxis (for N. gonorrhoeae or C. trachomatis) Warnings: blurring of vision (for about 20 minutes after application)--warn pt on dangers in operating heavy machinery Considerations in choosing this drug: This drug is the only approved medication for ophthalmia neonatorum prophylaxis. For superficial ocular infections involving the conjunctiva/cornea, the only other first line agent is polymyxin/trimethoprim solution. Polymyxin/trimethoprim solution (drops) may be preferred in adults who do not want the blurred vision that comes with the erythromycin ointment. Reasons to recommend other drugs (not on $4 list): Fluoroquinolones are best for corneal ulcers and for treating pseudomonas; however, resistance is emerging and cost is high. If pseudomonas is suspected (suspect it in contact lens wearers once keratitis has been ruled out), definitely prescribe a fluoroquinolone (Ocuflox).

Pharmacologic category/Drug class: NSAID MOA: inhibits cyclooxgenase, reducing prostaglandin and thromboxane synthesis. Pharmacokinetics and dynamics: taken PO BID FDA approved uses: Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis, Acute gout, Pain mild-moderate, Dysmenorrhea, Anti-inflammatory. Non FDA approved uses: Chronic fatigue syndrome, Fibromyalgia Adverse effects: dyspepsia, nausea, abdominal pain

Pharmacologic category: Antitussive Drug class: Antitussive, nonnarcotic MOA: Anesthetizes respiratory passage, lung, and pleural stretch receptors, reducing cough reflex Pharmacokinetics and pharmacodynamics: No known DDIs, though it is advised to not mix benzonatate with other medications that cause drowsiness FDA Approved Uses: Cough Adverse Effects: Sedation Warning: Severe hypersensitivity reactions, including bronchospasm, laryngospasm, and cardiovascular collapse, have been reported. Such reactions may have resulted from local anesthesia secondary to sucking or chewing the liquid-filled capsules rather than swallowing them whole. Accidental ingestion of benzonatate by children under the age of 10 years can result in death from overdose. Overdose with benzonatate in children less than 2 years of age has been reported following accidental ingestion of as few as 1 or 2 capsules. Reasons to recommend other drugs: I would still prescribe benzonatate over Codeine, just because of the addictive nature of Codeine. However, dextromethorphan might be a better option for pediatric patients as young as 4 years old with a cough, as it is not advised to give benzonatate to children under 10 years old

Pharm Category: Hormone Therapy Drug Class: Estrogens MOA: Binds to Estrogen receptors FDA Approval: (women without a uterus) Vasomotor Sx for Mod-Severe Menopause Vulvuvaginal artrophy menopausal Osteoporosis prevention, postmenopausal Adverse Effects: Thromboembolism Stroke Heart Disease Breast Cancer Endometrial Cancer Considerations for Method: Women with Liver or Gallbladder disease should use vaginal, not oral **FYI**: If your pt has a uterus, would want to consider a hormone replacement that contains progesterone

Pharmacologic category BLOOD PRESSURE DRUGS/ ANTIHYPERTIENSIVE Drug Class-Diuretics - K+ Sparing Diuretics MOA: antagonizes aldosterone-specific mineralocorticoid receptors primarily in the distal convoluted tubule, decreasing Na and water reabsorption and increasing K retention (Aldosterone acts in the distal tubules and collecting ducts to retain Na+ and excrete K+ and H+, increase water retention, and increase BP) FDA: Spironolactone: - EDEMA, HTN , Hyperaldosteronism, Hypokalemia Diuretic induced, Acne vulgaris and idiopathic hirsutism. HF: Prevents the cardiac remodeling that occurs as compensation with disease progression NON FDA: Acne vulgaris and idiopathic hirsutism. Pregnancy category- D Spironolactone is rarely used alone- additive to other drugs ie thiazides or loop diuretics for potassium sparing effects.

Drug Class: Mood stabilizer, carboxamide, Anti- epileptic agent MOA: reduces post-tetanic potentiation, decreasing seizure spread; exact mechanism of action in trigeminal neuralgia or bipolar disorder unknown FDA Approved Uses: Bipolar Disorder, Trigeminal Neuralgia, Seizure Disorder Non FDA Approved Uses: restless leg syndrome Adverse Effects: Drowsiness Black Box Warnings: Serious Dermatologic Rxns and HLA-B*1502 Allele serious, sometimes fatal dermatologic reactions reported, including toxic epidermal necrolysis and Stevens-Johnson syndrome; risk 10x greater in some Asian countries; strong association between risk and HLA-B*1502 allele, which is found almost exclusively in Asian patients; screen patients of genetically at-risk ancestry for HLA-B*1502 allele before initiating tx.

Pharmacologic category: GI stimulant Drug class: antidopaminergic and GI stimulant MOA: 1) stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. 2) The antiemetic properties of metoclopramide appear to be a result of its antagonism of central and peripheral dopamine receptors. Pharmacodynamics: stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. Metoclopramide increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenal bulb, and increases peristalsis of the duodenum and jejunum resulting in accelerated gastric emptying and intestinal transit. It increases the resting tone of the lower esophageal sphincter. FDA Approved Uses: The use of metoclopramide tablets is recommended for adults only. Therapy should not exceed 12 weeks in duration. Symptomatic Gastroesophageal Reflux - If symptoms are confined to particular situations, such as following the evening meal, use of metoclopramide as single doses prior to the provocative situation should be considered, rather than using the drug throughout the day. Diabetic Gastroparesis (Diabetic Gastric Stasis) Non-FDA-approved Uses: Gastroparesis due to other causes besides diabetes, morning sickness (nausea & vomiting) during pregnancy, nausea & vomiting due to migraines, and stimulation of breast milk production Warnings: BLACK BOX WARNING - TARDIVE DYSKINESIA Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose. Metoclopramide therapy should be discontinued in patients who develop signs or symptoms of tardive dyskinesia. There is no known treatment for tardive dyskinesia. In some patients, symptoms may lessen or resolve after metoclopramide treatment is stopped. Mental depression has occurred in patients with and without prior history of depression. Symptoms have ranged from mild to severe and have included suicidal ideation and suicide. Metoclopramide should be given to patients with a prior history of depression only if the expected benefits outweigh the potential risks. Choosing between this drug and others on the $4 list: For patients with GERD consideration should be given to the H2 blockers as treatment option prior to metoclopramide due to a better side effect profile and no black box warning. For the same reasons, promethazine should be considered first in patients with nausea and vomiting.

Pharmacologic Category: Non-Opioid Analgesic (NSAID) Drug Class: Non-selective NSAID (Acetic Acid Derivative) MOA: inhibits cyclooxygenase, reducing prostaglandin and thromboxane synthesis FDA-approved uses: Acute gout attack, osteoarthritis, rheumatoid arthritis, acute bursitis/tendonitis, ankylosing spondylitis, patent ductus arteriosus Non-FDA approved (off-label) uses: dysmenorrhea, mild-moderate pain 5 Most common adverse effects: Nausea/abdominal pain, constipation, headache, dizziness, rash Black Box Warnings: 1) Cardiovascular risk: may increase risk of serious and potentially fatal cardiovascular thrombotic events, MI, and stroke. 2) GI risk: increased risk of serious GI adverse events including bleeding, ulcer, and stomach or intestine perforation. Elderly pts at greater risk for serious GI events. Special considerations in choosing between different preparations: For the closure of PDA in neonates, the IV form of Indomethacin is used. Considerations in choosing between the other drugs in same category on $4 list: According to Epocrates, there is no evidence that indomethacin is superior to other NSAIDS. Naproxen, ibuprofen, diclofenac, meloxicam, and indomethacin are all listed as primary options for 1st line treatment of acute gout attacks (all are on the $4 list). Any particular reason you would recommend one of the other drugs above (not on the $4 list) INSTEAD of this drug which IS on the $4 list? For general mild to moderate pain I would recommend using a different NSAID, such as ibuprofen or naproxen (although they are on the $4 list), because indomethacin is not FDA approved for mild to moderate pain unless it is caused by an acute gout attack, osteoarthritis, rheumatoid arthritis, acute bursitis/tendonitis, or ankylosing spondylitis.

Beta lactam, First Gen cephalosporin Bacteriacidal-inhibits cell wall mucopeptide synthesis Taking cephalexin may decrease the efficacy of birthcontrol pills FDA approved for: uncomplicated bacterial skin infections, strep pharyngitis, and uncomplicated UTI Most common side effect is GI complaints (nausea, upset stomach, Vomiting) Cephalexin can be used for cellulitis, however if there is concern of MRSA, TMP-SMX should be used instead from the $4 list

Pharm Category: Steroidal Anti-inflammatory, antipruritic, immunosuppressant Drug Class: Corticosteroid MOA: Causes vasoconstriction of skin blood vessels by inhibiting phospholipase A2; decreases concentration of leukocytes and suppresses cytokines Administered Topically Absorption: not absorbed by normal, healthy skin; absorption is increased with inflamed and exfoliative conditions; absorption increases with occlusion therapy FDA approved uses: Relief of inflammation form steroid-responsive dermatoses; mild-to-moderate atopic dermatitis; inflamed hemorrhoids Warnings: Adrenal suppression- Particularly in younger children or in patietns receiving high doses Any special considerations in choosing between different preparations (ointment vs cream, tab vs capsule, suspension vs solution, etc.): The ointment is more effective than the cream, but the cream is less messy so it is a matter of patient compliance. Considerations in choosing between the other drugs in same category on $4 list: Triamcinolone .5% cream is a high potency corticosteroid that is used for thicker areas that are resistant to hydrocortisone; higher potency drugs would also be more likely to be used on the trunk, extremities and the scalp, while the low potency drugs, are more likely to be used on the face, axilla, and genital region

Pharmacologic category: Antibacterial Drug Class: Ophthalmic MOA: bacteriostatic competitively inhibits bacterial or fungal dihydropteroate synthetase, preventing PABA conversion to folic acid inhibiting growth FDA-approved use: Treatment and prophylaxis of conjunctivitis and other superficial ocular infections due to susceptible organisms. Adverse Effects: Burning, irritation, stinging Warning: hypersens. to sulfonamides, silver ophthalmic perparations, contact lens use Special Considerations in Choosing between Different Preparations: available in ophthalmic solution and ointment for the eye, ointment may be preferred in children above 2 months of age that have trouble with the administration of solution.

Drug Category: Antihistamine (2nd generation) Drug class: H1 antagonist FDA-approved uses: Relief of nasal and non-nasal symptoms of seasonal allergic rhinitis; treatment of chronic idiopathic urticaria Adverse effects: drowsiness, dry mucous membranes Any special considerations: Age will largely determine oral administration type. For instance, 2-5mg of syrup should be used in children ages 2-5 yo. Loratadine is the best drug on the $4 list to use specifically for allergic rhinitis. Because it is the only selective H1 antagonist on the $4 list, it will act more peripherally, rather than directly affecting the CNS.

Pharmacologic category: Antidepressant/Insomnia MOA: Weak serotonin reuptake inhibitor, potent H1 Histamine & mild α-1 adrenergic antagonist FDA use: Major Depressive Disorder Non-FDA approved uses: widely used for Insomnia (low doses) Adverse Reactions: Serious effects: suicidality, serotonin syndrome, QT prolongation Common Reactions: Somnolence, xerostomia, N/V, constipation, sexual dysfxn Warnings: BBW: Suicidality - increased suicidality risk in children, adolescents and young adults w/major depressive or other psychiatric disorders

Category: Loop diuretic Class: Na+/K+/2Cl- co-transporter inhibitor MOA: Bumetanide inhibits sodium and chloride resorption by competing with chloride for the Na+/K+/2Cl- co-transporter in the ascending limb of the loop of Henle Bumetanide 96% plasma protein bound FDA approved uses: edema Unapproved uses HTN Adverse effects hyperuricemia, hypokalemia, hyponatremia, hyperglycemia Black box warning - Fluid and electrolyte depletion Take away point is to balance the patient's electrolytes

Pharmacologic Category: Dyslipidemia Drugs Drug Class: HMG- CoA Reductase Inhibitor with Statins MOA: Inhibit cholesterol synthesis by inhibiting HMG CoA reductase, increase cell surface LDL receptors that bind and internalize circulating LDL, stabilizes plaque, inhibits platelet thrombus formation, and anti-inflammatory Drug -Food Interactions: Alcohol and Grapefruit Excretion: Feces FDA Approved Uses: Hypercholesterolemia, mixed dyslipidemia, hypertriglyceridemia, CAD, CV event prevention Adverse Effects: Myopathy, rhabdomyolysis, myalgia, pain, N/V/D, HA, rash, fatigue Warning: Increased risk of myopathy and rhabdomyolysis when used with fibric acid agent Pregnancy Category X Pravastatin has less of an interaction with Warfarin compared to Lovastatin.

Pharmacologic Category: Bronchodilator Drug Class: Beta2-adrenergic agonist MOA: Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle. Common routes of administration: PO and Inhaled FDA Approved Uses: Bronchospasms, Prevention of Exercise-Induced Bronchospasms, Acute Asthma Non-FDA Approved (off-label) Uses: COPD Adverse Effects: Tachycardia, Lightheadedness, Nervousness Warnings: Hypokalemia can occur Avoid/Use Alternative with: Pseudoephedrine Special Considerations in Choosing between Different Preparations: Tabs and Syrup are extended-release, longer acting and are used for maintenance. Inhalers are used to prevent acute attacks and relieve exacerbations. Other Drugs in the Same Pharmacologic Category on the $4 list: Ipratropium Considerations in Choosing between the Other Drugs in the Same Category on the $4 List: Ipratropium is an adjunct to Albuterol and may be used in combination whereas Albuterol can be used individually.

Class- 5- alpha reductase inhibitor MOA: analog of testosterone that competitively inhibits the type II 5-alpha-reductase, the enzyme that converts testosterone to to 5-alpha-dihydrotestoterone Kinetics- 90% is bound to plasma protein FDA- approved- BPH, alopecia in men Non-FDA- alopecia in females Warnings- Women should avoid contact with crushed or broken tablets and semen from a partner treated with finasteride. Pregnancy Category: X

Womens Health Pharmacologic category- Selective estrogen receptor modulators (SERMs) Drug class- Mixed estrogenic antagonist and agonist properties. MOA: Tamoxifen binds to estrogen receptors (ER) and induces conformational changes in the receptor, Subsequent to tamoxifen ER binding, the expression of estrogen dependent genes (RNA transcription) is blocked or altered. FDA-approved uses: breast CA, metastatic, breast CA, adjuvant tx, ductal CA in situ (DCIS), breast CA prevention, mastalgia, ovulation induction, McCune-Albright syndrome Non-FDA approved uses- Gynecomastia Drugs in this class: Raloxifene(Evista), Toremifene (Fareston) Tamoxifen is the oldest and most studied drug of this class. Thus there is no indication to recommend one of the other drugs over it.

Pharmacologic category -Antianxiety Agent Drug class- Anxiolytics, Non-benzodiazepine Pharmacokinetics and pharmacodynamics- Protein binding: 86% to 95%; Drug Interactions: Grapefruit juice may cause increased buspirone concentrations; avoid intake of large quantities of grapefruit juice. St John's wort may decrease buspirone levels or increase CNS depression FDA-approved uses- Management of generalized anxiety disorder (GAD) Adverse Effects: Common reactions- Dizziness, drowsiness, nausea, diarrhea Warnings- Does not prevent or treat withdrawal from benzodiazepines.

Pharmacologic category: Diuretic (Triamterne); Antihypertensive: (Triamterene-HCTZ) Drug Class: Diuretic, Potassium Sparing MOA: Triamterene interferes with sodium and potassium exchange on the late distal convoluted tubule and collecting tubule of renal cells, by inhibiting sodium/potassium -ATPase. This leads to a decrease in the reabsorption of sodium and water, since sodium concentration is the main driving force of water reabsorption (producing only a modest diuretic effect since only 1-2% of sodium reabsorption occurs in this part of the nephron). The potassium-sparing aspect of triamterene makes it useful for combination with other diuretics, such as HCTZ, a thiazide diuretic that causes loss of potassium. In fact, although triamterene can be used alone for hypertension and edema (usually just edema), it is most often used in combination with HCTZ. Pharmacokinetics/Pharmacodynamics: Severe drug interactions include: other potassium-sparing diuretics, potassium bicarbonate, potassium chloride or any potassium salt. Moderate to severe interactions (monitor closely or modify treatment) include: ACE Inhibitors/ARBs. FDA-approved uses: Edema (when used alone) - generally peripheral edema. Non-FDA approved (off-label) uses: Hypertension when used in combination with HCTZ. Adverse Effects: Major Adverse Effects: Hyperkalemia - Black Box Warning - potentially fatal if not corrected; 10% incidence when used alone; 1-2% incidence when used in combination with thiazide diuretic; monitor potassium at start of treatment, dose change, and during any illness affecting renal function. Common Adverse Effects: N/V, diarrhea, xerostomia (dry mouth). Warnings/ Precautions: BBW for hyperkalemia. Avoid potassium supplements, potassium-containing salt substitutes, a diet rich in potassium, or other drugs that can cause hyperkalemia. On the $4 list, it is supplied as a tablet that consists of triamterene in combination with hydrochlorothiazide (Triamtrene-HCTZ). Special considerations in choosing between different preparations The only difference is that the capsule is only available in one dosage strength and the tablet is available in two strengths. Capsules are easier for some people to swallow than tablets, and capsules can often be opened up and the contents sprinkled on certain foods like apple sauce. Other $4 drugs in same category: Spironolactone is the only other potassium-sparing diuretic on the $4 list.

Pharmacologic category: Gout prophylaxis Drug Class: Xanthine oxidase inhibitor MOA: Inhibits xanthine oxidase, interfering w/ conversion of hypoxanthine and xanthine to uric acid FDA-approved uses: Allopurinol is indicated in: 1. The management of patients with signs and symptoms of primary or secondary gout (acute attacks, tophi, joint destruction, uric acid lithiasis, and/or nephropathy). 2. The mamagement of patients with leukemia, lymphoma and malignancies who are receiving cancer therapy which causes elevations of serum and urinary uric acid levels. 3. The mamagement of patients with recurrent calcium oxalate calculi whose daily uric acid exceeds 800 mg/day in males patients and 750 mg/day in females. Adverse Effects: Rash, Diarrhea, Nausea, Alk phos elevated, ALT, AST elevated, eosinophilia

Topical Antibiotic Topical Sulfonamide antibiotic MOA: competitively inhibits bacterial or fungal dihydropteroate synthetase, preventing PABA conversion to folic acid and inhibiting growth 2nd/3rd degree burns Adverse effects- Skin discoloration (some clinicians don't like to use it on the face for this reason) Don't use if patient has sulfa allergy

Pharmacologic Category: Intraocular Pressure-Lowering Agent Drug Class: Non-Selective Beta Blocker MOA: When applied topically to the eye, Timolol Maleate non-selectively antagonizes both beta-1 & beta-2 adrenergic receptors of the ciliary epithelium, which decreases aqueous humor production, thereby decreasing intraocular pressure. FDA Approved Uses: Chronic Open-Angle Glaucoma; Ocular Hypertension Non-FDA Approved Uses: Acute Angle-Closure Glaucoma (short-term use) Adverse Effects: Ocular burning & stinging upon instillation are the most common side effects. Contraindications: Bronchial Asthma or a history of Bronchospasm

Pharm category: Anti-arrhythmic Agent, Miscellaneous MOA: inhibits sodium-potassium ATPase thus increasing the force of myocardial contraction by increasing available intracellular calcium; increase vagal stimulation leading to decreased heart rate; slow conduction through atrioventricular node oral bioavailability is different between dosage forms; generic and brand name products of the same dosage forms. avoid haphazardly substituting different oral dosage forms or brand name products & generics because of the differing bio-availabilities long half life: 40 hours (ranging from 36-48) FDA approved:: treatment of congestive heart failure; to slow ventricular rate in tachyarrhythmias such as: atrial fibrillation, atrial flutter, supraventricular tachycardia; cardiogenic shock Non FDA: re-entrant PSTV (after carotid massage, IV adenosine, IV beta blocker, IV diltiazem) Adverse: High alert medication: the institute for safe medication practices includes digozin among the list of drugs which have heightened risk of causing significant patient harm when used in error. The safety margin of cardiac glycosides is very narrow! Serious adverse: AV block, severe bradycardia Most common: Diarrhea, Nausea/vomiting, abdominal pain, anorexia Old approach to treating heart failure was to use a combination of digoxin and a diuretic assuming there were no contraindications to these drugs. The new approach in management of heart failure is to use an ACEI with a diuretic and B-blocker.

Primary category: Antimanic Drug Class: Bipolar Disorder MOA: Alters cation transport across cell membrane in nerve and muscle cells and influences reuptake of serotonin and/or norepinephrine FDA-approved Uses: Adults and 12 yo + children: Bipolar and Mania Non-FDA approved Uses: Post traumatic stress disorder Adverse Effects: Fine hand tremor, dry mouth, altered taste perception, polyuria & n/v Warnings: Black Box Warning - Toxicity can occur at therapeutic levels.

Pharmacologic Category: Antimicrobial for Tuberculosis Drug Class: Antibiotic MOA: Isoniazid is a bactericidal agent that inhibits lipid and nucleic acid synthesis The following drugs should be eaten with caution, as they can cause a reaction that includes severe HA, large pupils, neck stiffness, n/v/d, flushing, sweating, itching, irregular heart beats, and chest pain: cheese, sour cream, beef or chicken liver, fish, prepared meats, avocados, bananas, raisins, sauerkraut, chocolate, caffeine, alcohol FDA Approved Uses: Active/Inactive Tuberculosis +/- HIV infection AEs: Paresthesias/Peripheral Neuropathy, N/V,

Drug Name: Atropine Sulfate op Pharmacologic category: Ophthalmic Drug class: anticholinergic. MOA: Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS; antagonizes acetylcholine receptors, inhibiting response of iris sphincter and ciliary body muscles (anticholinergic) FDA-approved uses: Produce mydriasis and cycloplegia for examination of the retina and optic disc and accurate measurement of refractive errors; produce papillary dilation in inflammatory conditions (eg, uveitis) Non-FDA approved (off-label) uses: pediatric amblyopia. Adverse effects: Local irritation, Hyperemia, Edema, Exudate, Follicular conjunctivitis, Vascular congestion, Dermatitis, Blurred vision, Hyperreactive response in Down's syndrome children (atropine), Drowsiness, Increased intraocular pressure, Physostigmine Warnings/ Precautions/ Contraindications: Narrow angle glaucoma, open angle glaucoma, hypersensitivity Pregnancy category: C Nursing mother recommendations: Trace amounts of atropine are excreted into breast milk. Anticholinergic agents may suppress lactation.

Pharm Category: Antihistamine/antiemetic Drug Class: 1st generation oral antihistamine, H1 antagonist MOA: Non-selectively antagonizes central and peripheral histamine H1 receptors; possesses anticholinergic effects, resulting in antiemetic and sedative effects. Penetrates the CNS to cause sedation. Alcohol increases the effects of this drug. FDA-approved uses: allergic conditions, nausea/vomiting, motion sickness, sedation Adverse Effects: BBW for respiratory depression. 5 most common effects are sedation, drowsiness, dry mouth, blurred vision, and photosensitivity. Also causes anticholinergic effects like urinary retention. Promathezine is the only antihistamine approved as an antiemetic.

Drug Class: Non-Selective NSAID MOA: Inhibits cyclooxygenase, reducing prostaglandin and thromboxane synthesis FDA Approved uses: RA, Ankylosing Spondylitis, Analgesia, Primary dysmennorhea, Acute pain, Migraine Adverse Effects: GI Bleeding, GI perforation/ulcer, abd pain, nausea, dyspepsia Contraindications: Aspirin or other aspirin containing drugs

Pharmacologic category (Antihypertensive, GI antispasmodic, NSAID, etc.) Fluoroquinolone Drug class (beta blocker, h1 antagonist, H2 blocker, SSRI, etc.) DNA gyrase inhibitors MOA: bactericidal Drug food: dairy products FDA-approved uses-infections, bacterial. UTI (uncomplicated and complicated), anthrax, acute sinusitis, chronic bacterial prostatitis, pneumonia, Non-FDA approved (off-label) uses-, salmonellosis (acute), , traveler's diarrhea, malignant otitis Externa, Adverse effects: N/V, Diarrhea, abdominal pain, QT prolongation Warnings/contradindications: Caution if tendon disorder hx Considerations in choosing between the other drugs in same category on $4 list-it's the only fluoroquinolone and is better than the other antibiotics because it has increased E. coli coverage

Category: Contraceptive Class: Progestin MOA: Inhibits pituitary gonadotropin release & prevents ovulation FDA: Contraception, endometriosis (pain) Non-FDA: Dysfunctional uterine bleeding Adverse Effects: Breakthrough bleeding/spotting may occur, weight gain Warnings: Be sure patient is not pregnant by confirming a negative pregnancy test or administering injection after the onset of normal menses: 14 wks apart, recheck for pregnancy Pregnancy Category: X

Category: an Insulin Secretagogue MOA: stimulates insulin receptors of beta cells of the pancrease by stimulating the sulfonaureal receptors 1/2 life: Longest half life of its class (10 h rs) (longer than Glipizide and Glimeperide) FDA: FDA approved to be used as an adjunct to Metformin for DM II treatment and Glyburide can be used as a monotherapy for DMII for those not tolerating Metformin Adverse Effects: Most commonly causing hypoglycemia, weight gain, and disulfarim-like reaction when used with alcohol If you have a Pt that has a renal disease or hepatic disease - choose another of the sulfonaureals like Glipizide or Glimeperide because they have shorter half lives and potentially less harmful in these pts. Warnings: Should not ever be used with sulfur based drugs like TMP-SMX Contraindicated in pts with severe renal or hepatic disease and Pts with sulfur allergies of course

Category: Anesthetic Class: Amide Local Anesthetic MOA: Inhibits NA ion channels, stabilizing neural cell membrane and inhibiting nerve impulse initiation and conduction For Oral topical use only, the solution should be swished around and spat out or swallowed slowly. Used for irritation of mucus membrane of the mouth or pharynx Used for procedures like introducing catheters into the respiratory tract

Pharmacologic category: Miotic Drug Class: Cholinergic MOA: Stimulates cholinergic receptors FDA: treatment of open angle glaucoma, acute closed angle glaucoma, and mydriasis reversal. Also used to reduce intraocular pressure after laser surgery. Warnings: Do not apply while wearing soft contact lenses. May cause blurry vision and decreased night vision. Consideration in choosing this drug and others on $4 list: Choose this drug for the treatment of acute closed angle glaucoma over the other drugs. Use the beta blockers for chronic open angle glaucoma.

Pharmacologic category Anticoagulant Drug class Vitamin K antagonist MOA: Vitamin K is required in order for the liver to synthesize coagulation factors II, VII, IX, X and proteins C and S. Active vitamin K is converted to an inactive form, which is then reactivated again by vitamin K epoxide reductase complex 1 (VKORC1). Warfarin works to competitively inhibit the subunit 1 of the multi-unit VKOR complex, thus depleting functional vitamin K reserves and hence reduces synthesis of active clotting factors. Protein binding: 99% FDA-approved uses - Prophylaxis and treatment of thromboembolic disorders and embolic complications arising from atrial fibrillation or cardiac valve replacement; adjunct to reduce risk of systemic embolism after myocardial infarction Non-FDA approved (off-label) uses - Prevention of recurrent transient ischemic attacks Adverse effects - Bleeding is the major adverse effect of warfarin.

Pharmacologic Category: Antihypertensive Drug Class: Vasodilator MOA: Directly dilates peripheral vessels FDA approved uses: Adults: HTN, Hypertensive Emergency, Preclampsia / Eclampsia Adverse Effects: Headache, tachycardia, flushing Other drugs not on $4 list: dihydropyridines Reasons to recommend other drugs not on $4 list: Dihydropyridines are used in patients who have HTN with PVD and used if needed to be combined w/ BBs; which the non-dihydropyridines cannot be combined with. (Side note: hydralazine can be combined with BB's). Hydralazine is not used as a primary drug for treating HTN b/c it elicits a reflex sympathetic stimulation of the heart (the baroceptor reflex).

Drug Class: Calcium Channel Blockers, Non-dihydropyridine MOA: It inhibits the influx of calcium ions into smooth muscle and cardiac muscle FDA approved use: A-Fib/A-Flutter, PSVT, HTN, Angina Non-FDA approved use: Prophylaxis of cluster migraines Common adverse effects: Peripheral edema, constipation Warnings: Contraindicated to be used with Beta Blockers, Alpha Blockers, Lomitapide, Niacin/Simvastatin, and Pimozide Other $4 drugs in same class: Verapamil Reasons to choose this over others: Verapamil is dosed q day and diltiazem is dosed BID. Diltiazem has more anti-arryhthmic properties

Pharmacologic Category: Anti-hypertensive Drug Class: Non-selective Beta Blocker (B1 and B2) MOA: Sympatholytic drug Selectively antagonizes alpha 1 adrenergic receptors Antagonizes beta-1 and beta 2 adrenergic receptors 3 main effects from this Decreases CO by decreasing HR and contractility Decreases sympathetic outflow from the CNS Inhibits the release of renin from the kidneys FDA Approved uses: HTN and CHF Adverse effects: Hypotension, Bradycardia, Fatigue, Hyperglycemia Warnings:Avoid in asthma, hepatic impairment, and acute decompensated heart failure

Category: GI antispasmodic Class: Anticholinergic MOA: The action of acetylcholine is blocked at parasympathetic sites in smooth muscle, secretory glands & the CNS Note: Avoid EtOH (may increase CNS depression) FDA: function bowel, IBS (irritable colon, spastic colon, mucous colitis) Non-FDA: urinary incontinence Adverse Effects: Dizziness (40%), Xerostomia (33%), Nausea (14%), Blurred vision (27%), Somnolence (9%) Warnings: CNS effects = may cause drowsiness, blurred vision, impaired physical or mental abilities; Counsel pts about mental alertness effects & to use caution when operating machinery or driving CONTRADICTIONS: obstructive disease of the GI tract, obstructive uropathy, glaucoma

Category: Contraceptives 1 Affecting distribution: St. John's Wart may decrease efficacy FDA approved: Dysfunctional uterine bleeding (moderate), dysmenorrhea, Endometriosis, Polycystic ovary syndrome, Hirsutism BBW: cigarette smoking increases risk of serious cardiovascular side effects, especially if over 35 yo Pregnancy category X

Treats anxiety, panic disorder, insomnia (trouble sleeping), and anxiety caused by depression. This medicine is a benzodiazepine. Brand names: Xanax, Niravam Legal status: Schedule IV controlled substance Pregnancy risk: Category D (Positive evidence of risk) May treat: Anxiety, Panic disorder, Agoraphobia, Depressive Disorder Drug class: Benzodiazepine Other drugs in same class: Clonazepam, Lorazepam, Diazepam, More

Promethazine (Phenergan) Given with demoral to prevent nausea and vomiting Prevents and controls motion sickness, nausea, vomiting, and dizziness. Also used to relieve or prevent allergic reactions, helps people go to sleep, and control their pain or anxiety before or after surgery or other procedures. Brand names: Phenergan, Phenadoz, Promethegan Pregnancy risk: Category C (Risk cannot be ruled out) May treat: Nausea, Pain, Allergy, Vomiting, Motion sickness, Perennial Allergic Rhinitis, Postoperative Complications Drug classes: Antiemetic, Phenothiazine Other drugs in same class: Ondansetron, Diphenhydramine

Valcyclovir: Valacyclovir is used to treat infections caused by certain types of viruses. In children, it is used to treat cold sores around the mouth (caused by herpes simplex) and chickenpox (caused by varicella zoster). In adults, it is used to treat shingles (caused by herpes zoster) and cold sores around the mouth. Valacyclovir is also used to treat outbreaks of genital herpes. In people with frequent outbreaks, this medication is used to reduce the number of future episodes.

USED for Acne vulgaris Benzoyl peroxide/clindamycin Brand names: BenzaClin, Acanya, Duac Combination of: Benzoyl peroxide, Clindamycin Pregnancy risk: Category C (Risk cannot be ruled out) Drug class: Lincosamides Other drugs in same class: Clindamycin, Clindamycin/tretinoin

Prevents and controls motion sickness, nausea, vomiting, and dizziness. Also used to relieve or prevent allergic reactions, helps people go to sleep, and control their pain or anxiety before or after surgery or other procedures.