Aricept - Memory

Duoneb - Lungs

Ecotrin -
325 mg Aspirin

Levaguin

Lorazepam

Memantine

Namenda

Neurontin
@Bedtime S4-15

Norvasc

Novolin - INSULIN - INJECTION

Risperdal
S4-15

Seroquel
D4-15

Synthroid

Tylenol

Zocor

Zoloft

Zyrtec

 

 

 

 

 

 

Aldean Redman Update

MEDICATIONS


GENERIC NAME: donepezil

BRAND NAME: Aricept, Aricept ODT

DRUG CLASS AND MECHANISM: Donepezil is an oral medication used to treat Alzheimer's disease. It belongs to a class of drugs called cholinesterase inhibitors that also includes tacrine (Cognex). Scientists believe that Alzheimer's disease may result from a deficiency in chemicals (neurotransmitters) used by nerves in the brain to communicate with one another. Donepezil inhibits acetylcholinesterase, an enzyme responsible for the destruction of one neurotransmitter, acetylcholine. This leads to increased concentrations of acetylcholine in the brain, and the increased concentrations are believed to be responsible for the improvement seen during treatment with donepezil. Donepezil improves the symptoms but does not slow down the progression of Alzheimer's disease. Donepezil was approved by the FDA in 1996.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Aricept is available in 5 and 10 mg tablets. Aricept ODT (orally disintegrating tablets) also are available in 5 and 10 mg tablets.

STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Donepezil is used for the treatment of mild to moderate dementia of the Alzheimer's type.

DOSING: Donepezil is generally taken once daily at night prior to retiring. Its absorption is not affected by food so that it may be taken with or without food.

DRUG INTERACTIONS: Drugs with anti-cholinergic properties that can cross into the brain, such as atropine, benztropine (Cogentin), and trihexyphenidyl (Artane) counteract the effects of donepezil and should be avoided during therapy with donepezil.

Donepezil is metabolized (eliminated) by enzymes in the liver. The rate of metabolism of donepezil may be increased by medications that increase the amounts of these enzymes, such as carbamazepine (Tegretol), dexamethasone (Decadron), phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin). By increasing elimination, these drugs may reduce the effects of donepezil.

Ketoconazole (Nizoral) has been shown to block the enzymes in the liver that metabolize donepezil. Therefore, concurrent use of ketoconazole and donepezil may result in increased concentrations of donepezil in the body and possibly lead to donepezil side effects. Quinidine (Quinidex, Quinaglute) also has been shown to inhibit the enzymes that metabolize donepezil and may cause donepezil side effects.

SIDE EFFECTS: The most frequently reported side effects associated with donepezil include headache, generalized pain, fatigue, dizziness, nausea, vomiting, diarrhea, loss of appetite, weight loss, muscle cramping, joint pain, insomnia, and increased frequency of urination.

Tacrine (Cognex), another anticholinesterase medication used in the treatment of Alzheimer's disease, is associated with liver toxicity. Donepezil does not appear to be associated with liver toxicity.


GENERIC NAME: levofloxacin

BRAND NAME: Levaquin

DRUG CLASS AND MECHANISM: Many common infections in humans are caused by single cell organisms, called bacteria. Bacteria can grow and multiply, infecting different parts of the body. Medicines that control and eradicate these bacteria are called antibiotics. Levofloxacin is an antibiotic that stops multiplication of bacteria by preventing the reproduction and repair of their genetic material (DNA). It is in a class of antibiotics called fluoroquinolones, a class that includes ciprofloxacin (Cipro), norfloxacin (Noroxin), ofloxacin (Floxin), trovafloxacin (Trovan), and lomefloxacin (Maxaquin). Levofloxacin was approved by the FDA in 1996.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Tablets: 250, 500, and 750 mg. Oral solution, 25 mg/mL.

STORAGE: Levofloxacin should be stored below 86°F.

PRESCRIBED FOR: Levofloxacin is used to treat infections of the sinuses, skin, lungs, ears, airways, bones, and joints caused by susceptible bacteria. Levofloxacin also is frequently used to treat urinary infections, including those resistant to other antibiotics, as well as prostatitis. Levofloxacin is effective in treating infectious diarrheas caused by E. coli, campylobacter jejuni, and shigella bacteria. Levofloxacin also can be used to treat various obstetric infections, including mastitis.

DOSING: Levofloxacin usually is given once daily. It is important to take it at least 2 hours before or 2 hours after any antacid, or mineral supplement with iron, calcium, zinc, or magnesium since these minerals bind levofloxacin and prevent its absorption.

DRUG INTERACTIONS: Minerals with 2 or 3 positive charges, called divalent or trivalent ions, respectively, can attach to levofloxacin and other fluoroquinolones and prevent their absorption from the intestine into the blood. Therefore, such products (containing iron, calcium, zinc, or magnesium) as well as antacids, should be taken at least 2 hours before or 2 hours after levofloxacin. Other drugs which contain these ions and which can similarly interact with levofloxacin include sucralfate (Carafate) and didanosine, dDI.

Taking non-steroidal anti-inflammatory drugs (NSAIDs) with levofloxacin may increase the risk of CNS stimulation, resulting in over-excitation. There have been reports of changes in blood sugar in patients treated with other fluoroquinolones and antidiabetic agents. Other fluoroquinolones have been reported to increase blood levels of theophylline (Theodur), warfarin (Coumadin), and cyclosporine (Sandimmune; Neoral). There have not yet been similar reports with levofloxacin.

SIDE EFFECTS: The most frequently reported side events are nausea or vomiting (1 out of every 12 persons), diarrhea (1 out 20), headache (1 out 20), and constipation (1 out of 30). Less common side effects include difficulty sleeping, dizziness, abdominal pain, rash, abdominal gas, and itching.


Lorazepam

BRAND NAME: Ativan

Lorazepam is an antianxiety medication in the benzodiazepine family, the same family that includes diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), flurazepam (Dalmane), and others. Lorazepam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter, a chemical that nerves in the brain use to send messages to one another. GABA inhibits activity in many of the nerves of the brain, and it is thought that this excessive activity is what causes anxiety or other psychological disorders. Because lorazepam is removed from the blood more rapidly than many other benzodiazepines, there is less chance that lorazepam concentrations in blood will reach high levels and become toxic. Lorazepam has fewer interactions with other medications than most of the other benzodiazepines.

PRESCRIBED FOR: Lorazepam is used for the management of anxiety disorders, the short-term relief of the symptoms of anxiety or anxiety associated with depression. The effectiveness of lorazepam, or other benzodiazepines , have not been adequately studied for treatment beyond 4 months. Lorazepam also has been shown to be effective for improving sleep in people with insomnia, for panic attacks, and as an adjunct (i.e., when added to other medications) to prevent nausea and vomiting in patients receiving cancer chemotherapy.

DOSING: The dose of lorazepam is tailored to the patient's needs. Scheduled doses, given twice or three times daily, are sometimes used for persons with continuous anxiety or at bedtime for insomnia. Alternatively, lorazepam may be prescribed on as "as needed" basis, the physician instructing the patient to take lorazepam when he/she feels anxious.

DRUG INTERACTIONS: Lorazepam and all benzodiazepines, interact with other medications and drugs that slow the brain's processes such as alcohol, barbiturates, and narcotics. There have been cases of marked sedation when lorazepam was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction at all, but concern is warranted.


GENERIC NAME: Memantine

BRAND NAME: Namenda

DRUG CLASS AND MECHANISM: Memantine is an oral medication for treating patients with Alzheimer's disease. Other medications used for Alzheimer's disease affect acetylcholine, one of the neurotransmitter chemicals that nerve cells in the brain use to communicate with one another. These drugs--galantamine (Reminyl), donezepil (Aricept), rivastigmine (Exelon), and tacrine (Cognex)-- inhibit the enzyme acetylcholinesterase that destroys acetylcholine and thereby increases the effects of acetylcholine. Memantine's effects are independent of acetylcholine and acetylcholinesterase.

Glutamate is the main excitatory neurotransmitter in the brain. It is believed that too much stimulation of nerve cells by glutamate may be responsible for the degeneration of nerves that occurs in some neurological diseases such as Alzheimer's disease. Like other neurotransmitters, glutamate is produced and released by nerve cells in the brain. The released glutamate then travels to nearby nerve cells where it attaches to a receptor on the surface of the cells called the N-methyl-D-aspartate (NMDA) receptor. Memantine blocks the receptor and thereby decreases the effects of glutamate. It is thought that by blocking the NMDA receptor and the effects of glutamate, memantine may protect nerve cells from excess stimulation by glutamate. Memantine was approved by the FDA in October, 2003.

PRESCRIPTION: Yes.

GENERIC AVAILABLE: No.

PREPARATIONS: Tablets: 5 mg (tan) and 10 mg (gray).

STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Memantine is used for the treatment of moderate to severe dementia of the Alzheimer's type. Dementia can be categorized into three levels of severity. Mild: Patients are alert and sociable, but forgetfulness begins to interfere with daily living. Moderate: This is often the longest stage of the disease with deterioration of intellect, logic, behavior, and function. Severe: Loss of long-term memory and language skills. Patients may require 24-hour care and can no longer complete basic self-care tasks including washing, eating, and using the bathroom.

DOSING: The usual starting dose of memantine is 5 mg once daily. The dose usually is increased to 5 mg twice daily, then 5 mg and 10 mg as separate doses daily, and finally 10 mg twice daily. Memantine can be taken with or without food.

DRUG INTERACTIONS: Medicines that make the urine more alkaline (for example, carbonic anhydrase inhibitors such as acetazolamide (Diamox) and sodium bicarbonate would be expected to reduce the elimination of memantine by the kidneys and might increase the blood levels and the risk of side effects of memantine. Combining memantine with other NMDA receptor antagonists (for example, amantadine (Symmetrel), ketamine, and dextromethorphan) has not been evaluated and should be approached cautiously.

SIDE EFFECTS: The most common side effect of memantine are fatigue, pain, increases in blood pressure, dizziness, headache, constipation, vomiting, back pain, confusion, somnolence, hallucination, coughing, and difficulty in breathing. The side effects are most often mild to moderate.


GENERIC NAME: memantine

BRAND NAME: Namenda

DRUG CLASS AND MECHANISM: Memantine is an oral medication for treating patients with Alzheimer's disease. Other medications used for Alzheimer's disease affect acetylcholine, one of the neurotransmitter chemicals that nerve cells in the brain use to communicate with one another. These drugs--galantamine (Reminyl), donezepil (Aricept), rivastigmine (Exelon), and tacrine (Cognex)-- inhibit the enzyme acetylcholinesterase that destroys acetylcholine and thereby increases the effects of acetylcholine. Memantine's effects are independent of acetylcholine and acetylcholinesterase.

Glutamate is the main excitatory neurotransmitter in the brain. It is believed that too much stimulation of nerve cells by glutamate may be responsible for the degeneration of nerves that occurs in some neurological diseases such as Alzheimer's disease. Like other neurotransmitters, glutamate is produced and released by nerve cells in the brain. The released glutamate then travels to nearby nerve cells where it attaches to a receptor on the surface of the cells called the N-methyl-D-aspartate (NMDA) receptor. Memantine blocks the receptor and thereby decreases the effects of glutamate. It is thought that by blocking the NMDA receptor and the effects of glutamate, memantine may protect nerve cells from excess stimulation by glutamate. Memantine was approved by the FDA in October, 2003.

PRESCRIPTION: Yes.

GENERIC AVAILABLE: No.

PREPARATIONS: Tablets: 5 mg (tan) and 10 mg (gray).

STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Memantine is used for the treatment of moderate to severe dementia of the Alzheimer's type. Dementia can be categorized into three levels of severity. Mild: Patients are alert and sociable, but forgetfulness begins to interfere with daily living. Moderate: This is often the longest stage of the disease with deterioration of intellect, logic, behavior, and function. Severe: Loss of long-term memory and language skills. Patients may require 24-hour care and can no longer complete basic self-care tasks including washing, eating, and using the bathroom.

DOSING: The usual starting dose of memantine is 5 mg once daily. The dose usually is increased to 5 mg twice daily, then 5 mg and 10 mg as separate doses daily, and finally 10 mg twice daily. Memantine can be taken with or without food.

DRUG INTERACTIONS: Medicines that make the urine more alkaline (for example, carbonic anhydrase inhibitors such as acetazolamide (Diamox) and sodium bicarbonate would be expected to reduce the elimination of memantine by the kidneys and might increase the blood levels and the risk of side effects of memantine. Combining memantine with other NMDA receptor antagonists (for example, amantadine (Symmetrel), ketamine, and dextromethorphan) has not been evaluated and should be approached cautiously.

SIDE EFFECTS: The most common side effect of memantine are fatigue, pain, increases in blood pressure, dizziness, headache, constipation, vomiting, back pain, confusion, somnolence, hallucination, coughing, and difficulty in breathing. The side effects are most often mild to moderate.


GENERIC NAME: gabapentin

BRAND NAME: Neurontin

DRUG CLASS AND MECHANISM: Gabapentin is in the class of drugs called anticonvulsants because they are used to treat seizures (epilepsy) and herpes zoster (shingles). Gabapentin is related to the brain chemical gamma aminobutyric acid (GABA) but exactly how it works is unknown.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Capsules are available in 100mg, 300mg, 400mg, and 800mg sizes by Park-Davis labs.

STORAGE: Store in a dry place at 15-30 degrees C (69-86 F)

PRESCRIBED FOR: Gabapentin is used for treating seizure disorders and herpes zoster (shingles).

DOSING: Gabapentin can be taken with or without food at doses specifically directed by your physician. Individual doses vary greatly between individuals. Usually the drug is taken two to three times daily. It is currently not approved under the age of 12 years old. If discontinued, gabapentin should be gradually withdrawn (usually over one week) as directed by the doctor.

DRUG INTERACTIONS: Gabapentin appears to be relatively safe and has not been shown to interact with other drugs except for it's potential of added sedation. Gabapentin should not be taken within 2 hours of Maalox. Gabapentin may interfere with the reading of N- Multistix in detecting urine protein.

SIDE EFFECTS: Neurontin has few side effects which include sleepiness, dizziness, unsteady gait, fatigue and eye twitching.


GENERIC NAME: amlodipine

BRAND NAME: Norvasc

DRUG CLASS AND MECHANISM: Amlodipine belongs to a class of medications called calcium channel blockers. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, amlodipine is useful in preventing chest pain (angina) resulting from coronary artery spasm. Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart as it pumps blood to the body. Reducing heart burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina in patients with coronary artery disease. For more detailed information related to coronary artery disease, please read the Chest Pain, Cholesterol, and Heart Attack articles.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Tablets ( 2.5mg, 5mg, 10mg.)

STORAGE: Amlodipine should be stored at room temperature in a tight, light resistant container.

PRESCRIBED FOR: Chest pain (angina) occurs because of insufficient oxygen delivered to the heart muscles. Insufficient oxygen may be a result of coronary artery blockage or spasm, or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. Amlodipine is used for the treatment and prevention of angina resulting from coronary spasm as well as from exertion. Amlodipine is also used in the treatment of high blood pressure.

DOSING: Amlodipine can be taken with or without food. Amlodipine is metabolized mainly by the liver and dosages may need to be lowered in patients with liver dysfunction.

DRUG INTERACTIONS: In patients with severe coronary artery disease, amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur, especially in patients already taking another blood pressure lowering medication. In rare instances, congestive heart failure has been associated with amlodipine, usually in patients already on a beta blocker. For further information on beta blockers, please read the propranolol (Inderal) article.

SIDE EFFECTS: Side effects of amlodipine are generally mild and reversible. The two most common side effects are headache and edema (swelling) of the lower extremities. Less common side effects include dizziness, flushing, fatigue, nausea, and palpitations.


GENERIC NAME: INSULIN - INJECTION (IN-sue-lin)

BRAND NAME(S): Humulin, Iletin I NPH, Novolin

USES: Insulin is used to treat diabetes mellitus. Controlling high blood sugar helps prevent heart disease, strokes, kidney disease, circulation problems, and blindness.

HOW TO USE: Insulin must be injected. Learn the proper way to inject insulin. Check the dose carefully. Clean the injection site with rubbing alcohol. Change the injection site daily to prevent skin bulges or pockets. Do not inject cold insulin. The insulin container you are currently using can be kept at room temperature. The length of time you can store it at room temp. depends on the product. Consult your pharmacist. Insulin is frequently injected 30 minutes before a meal. Some inject at bedtime. Ask your pharmacist or nurse for details of injecting insulin as it varies depending on your insulin treatment plan. Monitor your urine or blood sugar as prescribed. Keep track of your results. This is very important in order to determine the correct insulin dose. Follow all of your doctor's directions carefully.

SIDE EFFECTS: Insulin may cause minor and usually temporary side effects such as rash, irritation or redness at the injection site. To help prevent hypoglycemia, eat meals on a regular schedule. Too much insulin can cause low blood sugar (hypoglycemia). The symptoms include cold sweat, shaking, rapid heart rate, weakness, headache and fainting which, if untreated, may lead to slurred speech and other behaviors that resemble drunkenness. If you experience these symptoms, eat a quick source of sugar such as glucose (glutose, etc.) table sugar, orange juice, honey or non-diet soda. Tell your doctor about the reaction. Too little insulin can cause symptoms of high blood sugar (hyperglycemia) which include confusion, drowsiness, rapid breathing, fruity breath odor, increased urination or unusual thirst. If these symptoms occur, contact your doctor. Your insulin dose needs adjustment. In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor if you have had allergic reactions, especially to beef, pork or human insulin and of your medical history especially of: thyroid problems, kidney or liver disease, any current infection. Dosage adjustments may be required when you become ill, are under stress, or when quitting smoking. Consult your doctor if you catch a cold or the flu, become nauseated or if your blood glucose levels are high. Fat deposits can occur if injection site is not rotated. Check your sugar readings before and after exercise. You may need a snack beforehand. Tell your doctor if you are pregnant before using this drug. Insulin is not excreted into breast milk. Nevertheless, consult your doctor before breast-feeding.

DRUG INTERACTIONS: Before you use insulin, tell your doctor of all prescription and nonprescription drugs you are taking especially: beta-blockers (acebutolol, atenolol, betaxolol, esmolol, metoprolol, carteolol, nadolol, penbutolol, pindolol, propranolol, timolol, bisoprolol), fenfluramine, MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, selegiline, tranylcypromine), salicylates (aspirin-like compounds), dexfenfluramine, steroids (e.g., prednisone, hydrocortisone), birth control pills, sulfa antibiotics, water pills, ACE inhibitors, octreotide, isoniazid, niacin, estrogens, cold and allergy drugs, drugs that contain alcohol or sugar. Other medications can affect the action of insulin and can alter the results of urine tests for sugar or ketones. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include unconsciousness, seizures, muscle weakness, slow or shallow breathing, headache, vomiting, fever, diarrhea, shakiness, nervousness, fast heartbeat, hunger, or sweating.

NOTES: Do not share this medication with others. It is recommended you attend a diabetes education program to understand diabetes and all important aspects of its treatment including meals/diet, exercise, personal hygiene, medications and getting regular eye, foot and medical exams. Consult your doctor or pharmacist. Keep all medical appointments. Laboratory and/or medical tests (e.g., liver and kidney function tests, fasting blood glucose, hemoglobin A1c, complete blood counts) will be performed to monitor for side effects and response to therapy. Regularly check your blood or urine for sugar, as directed by your doctor or pharmacist.

MISSED DOSE: It is very important to follow your insulin regimen exactly. Do not miss any doses of insulin. Discuss specific instructions with your doctor now, in case you miss a dose of insulin in the future.

STORAGE: Insulin may be stored under refrigeration up to the expiration date noted on the package and must be discarded after that date. Consult your pharmacist for the storage requirements of your particular form/type of insulin, including room temperature storage options. Do not expose insulin to heat or sunlight. Do not freeze.


GENERIC NAME: risperidone

BRAND NAME: Risperdal

DRUG CLASS AND MECHANISM: Risperidone is an antipsychotic medication that works by interfering with the communication among nerves in the brain. The nerves communicate with one another by producing and releasing chemicals called neurotransmitters. The neurotransmitters attach to receptors on other nearby nerves, and the attachment of the neurotransmitter causes changes in the cells that have the receptor on them. Risperidone blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors and this blocks communication among nerves. Risperidone is a relatively new antipsychotic medication that probably has fewer side effects than many of the older medications.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets of 1, 2, 3, and 4 mg.
(0.25 Mg AM&PM)

STORAGE: Tablets should be kept at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Risperidone is used for the treatment of psychotic disorders, for example, schizophrenia. It also is used in combination with lithium or valproate for the treatment of acute manic or mixed episodes associated with bipolar I disorder.

DOSING: Risperidone usually is begun as two small doses each day. The doses often are increased every few days or each week until the optimal dose is found. Patients who are elderly or have kidney disease may need lower doses since the kidneys, which are partially responsible for removing risperidone from the blood, remove risperidone more slowly, and this can lead to toxic levels of risperidone in the blood. Similarly, patients with liver disease may need lower doses since the liver also is partially responsible for removing risperidone.

DRUG INTERACTIONS: Risperidone may interfere with elimination by the kidneys of clozapine (Clozaril), a different type of antipsychotic medication, causing increased levels of clozapine in the blood. This could increase the risk of side effects with clozapine.

SIDE EFFECTS: The most commonly noted side effects associated with risperidone are extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity, tiredness, and nausea. Risperidone may cause a condition called orthostatic hypotension during the early phase of treatment (the first week or two). Patients who develop orthostatic hypotension have a drop in their blood pressure when they rise from a lying position and may become dizzy.

Although there is no clear link between risperidone and diabetes, patients should be tested during treatment for elevated blood-sugars. Additionally, persons with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during treatment should be tested for diabetes.


quetiapine

BRAND NAME: Seroquel (Discontinued 4-14)

DRUG CLASS AND MECHANISM: Quetiapine is an oral antipsychotic drug used for treating schizophrenia and bipolar disorder. Although the mechanism of action of quetiapine is unknown, like other anti-psychotics, it inhibits communication between nerves of the brain. It does this by blocking receptors on the nerves for several neurotransmitters, the chemicals that nerves use to communicate with each other. It is thought that its beneficial effect is due to blocking of the dopamine type 2 (D2) and serotonin type 2 (5-HT2) receptors.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets: 25, 50, 100, 200, 300, and 400 mg

STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Quetiapine is used alone or in combination with other drugs to treat schizophrenia and bipolar disorder .

DOSING: Quetiapine usually is taken two or three times daily. The dose usually is increased slowly over several days or weeks to achieve the desired effect. Quetiapine can be taken with or without food.

The initial dose for bipolar disorder is 50 mg twice daily (100 mg/d). The dose can be increased by 100 mg/d to a daily dose of 400 mg/d. Most patients respond to 400-800 mg/d. Doses greater than 800 mg/d have not been studied.

The initial dose for schizophrenia is 25 mg twice daily (50 mg/d). The dose can be increased by 25-50 mg two or three times daily. The target dose is 300-400 mg/d in two or three doses. Patients respond to 150-750 mg/d, and doses greater than 800 mg/d have not been evaluated.

DRUG INTERACTIONS: Phenytoin (Dilantin) and thioridazine (Mellaril) markedly decrease the amount of quetiapine that is absorbed from the intestine and thereby reduces its effectiveness. Therefore, patients taking phenytoin or thioridazine may require higher doses of quetiapine.

Quetiapine can cause hypotension (low blood pressure) and therefore increase the blood pressure lowering effects of antihypertensive drugs.

Quetiapine can increase the sedating effects of other drugs that sedate. Such drugs include narcotic pain relievers (e.g., Percocet), barbiturates, sedatives such as alprazolam (Xanax) and clonazepam (Klonopin), ethanol, and blood pressure drugs that can cause orthostatic hypotension, such as prazosin (Minipress) and terazosin (Hytrin).

Quetiapine is eliminated from the body by an enzyme in the liver called cytochrome P450 3A. There is a concern that drugs that strongly interfere with the enzyme, e.g., ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan), and erythromycin, clarithromycin (Biaxin), nefazodone (Serzone), verapamil (Calan, Isoptin, Verelan), or diltiazem (Cardizem, Tiazac, Dilacor) may cause elevated and toxic levels of quetiapine.

SIDE EFFECTS: Frequent adverse effects include headache, agitation, dizziness, drowsiness, weight gain and stomach upset. Quetiapine can cause orthostatic hypotension (a drop in blood pressure upon standing that can lead to dizziness or fainting) especially during the first 3-5 day period of treatment, when it is restarted after temporary discontinuation, and after an increase in the dose. The risk of orthostatic hypotension is about 1 in 100 (one of every hundred patients who takes quetiapine). Quetiapine frequently causes tiredness (1 in 5 patients), especially during the first 3-5 days of treatment. Because of this tiredness, care should be exercised in any activity requiring mental alertness such as operating a motor vehicle or hazardous machinery. Less common side effects include seizures (1 in 125 patients) and hypothyroidism (1 in 250 patients).

As with other antipsychotics, long-term use of quetiapine may lead to irreversible tardive dyskinesia, a neurologic disease which consists of involuntary movements of the jaw, lips, and tongue.

A potentially fatal complex referred to as neuroleptic malignant syndrome (NMS) has been reported with antipsychotic drugs. Patients who develop NMS may have high fevers, muscle rigidity, altered mental status, irregular pulse or blood pressure, rapid heart rate, excessive sweating, and heart arrhythmias.

In animals, quetiapine has been associated with the development of cataracts, and cataracts have been reported in patients using quetiapine for prolonged periods. Although it is not clear if quetiapine is responsible for the cataracts seen in humans, eye examinations by slit-lamp (to identify cataracts before they impair vision) are recommended at the beginning of treatment and every six months during treatment. If cataracts form, treatment should be discontinued.

Quetiapine may increase blood concentrations of cholesterol and triglycerides by 11% and 17%, respectively.

There is an increased risk of hyperglycemia (high blood glucose) and related events in patients taking atypical antipsychotics, including quetiapine. Patients should be tested during treatment for elevated blood-sugars. Additionally, persons with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during treatment should be tested for diabetes.


GENERIC NAME: levothyroxine sodium

BRAND NAME: Synthroid, Levoxyl, Levothroid, Unithroid

DRUG CLASS AND MECHANISM: Levothyroxine is a synthetic (man-made) version of the principle thyroid hormone, thyroxine (T4), that is made and released by the thyroid gland. Thyroid hormone increases the metabolic rate of cells of all tissues in the body. In the fetus and newborn, thyroid hormone is important for the growth and development of all tissues including bones and the brain. In adults, thyroid hormone helps to maintain brain function, food metabolism, and body temperature, among other effects.

GENERIC AVAILABLE: Yes. Generic and branded tablets of levothyroxine may differ in the amount of levothyroxine they contain, the absorption of the levothyroxine into the body, and the distribution of levothyroxine throughout the body. This means that ingestion of one mg of generic levothyroxine may not have the same effect on the body as one mg of another generic or branded levothyroxine. Practically speaking, this means that when changing between levothyroxine manufactured by different pharmaceutical companies, a change in dose may be necessary to maintain the desired effect or to prevent toxicity.

PRESCRIPTION: Yes.

PREPARATIONS: Tablets: 0.025, 0.05, 0.075, 0.088, 0.1, 0.112, 0.125, 0.137, 0.15, 0.175, 0.2, and 0.3 mg. Powder for intravenous injection: 6 and 10 ml vials containing 0.2 mg or 0.5mg of levothyroxine per vial.

STORAGE: Levothyroxine tablets usually are kept at room temperature, 15-30°C (59-86°F) in a light-resistant, tight container. However, some manufacturers vary in their storage recommendations. Therefore, storage conditions for each product should be clarified with a pharmacist.

Powdered levothyroxine for intravenous injection should be used immediately once mixed with a liquid.

PRESCRIBED FOR: Levothyroxine is approved to treat hypothyroidism and to suppress thyroid hormone release in the management of cancerous thyroid nodules and growth of goiters. In addition, Synthroid, Levoxyl and Levothroid also are prescribed with anti-thyroid drugs, for example methimazole (Tapazole), to manage thyrotoxicosis (high thyroid hormone levels due to over-activity of the thyroid gland). Thyrotoxicosis may result in the growth of goiters and/or hypothyroidism.

DOSING: Levothyroxine is usually started at 0.05 mg/day. Starting doses and dose changes may differ with individual patients based upon the presence of cardiovascular disease, the development of tolerance (reduced effectiveness with continued use), side effects to the medication, and blood levels of thyroid hormone. It may take one to three weeks after initiating therapy with levothyroxine or changing the dose before effects are seen.

DRUG INTERACTIONS: Initiation or discontinuation of therapy with levothyroxine in diabetic patients may create a need for an increase or decrease in the required dose of insulin and/or antidiabetic drug, e.g., glyburide (Micronase).

Levothyroxine may increase the effect of blood thinners such as warfarin (Coumadin). Therefore, monitoring of blood clotting is necessary, and a decrease in the dose of warfarin may be necessary.

Intravenous administration of epinephrine to patients with coronary artery disease may lead to complications ranging from difficulty in breathing to a heart attack. These complications may occur more frequently among patients also taking levothyroxine. Therefore, careful observation is needed when intravenous epinephrine is given to patients receiving levothyroxine who also have coronary artery disease.

Converting a state of hypothyroidism (underactivity) to a normal state (euthyroid state) with levothyroxine may decrease the actions of certain beta-blocking drugs, e.g., metoprolol (Lopressor) or propranolol (Inderal). It may be necessary, therefore, to change the dose of beta-blocker. For the same reason, the dose of digoxin (Lanoxin), a drug used to manage heart failure or an irregular heart rhythm (e.g., atrial-fibrillation), also may need to be changed.

Converting hypothyroidism to the euthyroid state with levothyroxine may increase the blood level of theophylline (Slo-Bid), and it may be necessary to change the dose of theophylline.

Taking levothyroxine at the same time as cholestyramine (Questran) or colestipol (Colestid), two cholesterol-lowering drugs, may decrease the effect of levothyroxine and lead to hypothyroidism. This occurs because the levothyroxine binds to the cholesterol-lowering drugs and is not absorbed. Taking the levothyroxine one hour before or four hours after cholestyramine or colestipol is necessary to prevent the binding.

SIDE EFFECTS: Levothyroxine therapy is usually well-tolerated. If symptoms occur, often they are due to toxic levels of thyroid hormone and the symptoms are those of hyperthyroidism. Symptoms may include all or some of the following: chest pain, increased heart rate or pulse rate, excessive sweating, heat intolerance, nervousness, headache, insomnia, diarrhea, vomiting, weight loss, or fever. Women may experience irregular menstrual cycles.


GENERIC NAME: acetaminophen

BRAND NAME: Tylenol and many other

DRUG CLASS AND MECHANISM: Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated. Acetaminophen was approved by the FDA in 1951.

PRESCRIPTION: no

GENERIC AVAILABLE: yes

PREPARATIONS: Liquid suspension, chewable tablets, coated caplets, gelcaps, geltabs, and suppositories. Common dosages are 325, 500 and 650 mg.

STORAGE: Store tablets and solutions at room temperature 15-30°C (59-86°F). Suppositories should be refrigerated below 27°C (80°F ).

PRESCRIBED FOR: Acetaminophen is used for the relief of fever as well as aches and pains associated with many conditions. Acetaminophen relieves pain in mild arthritis but has no effect on the underlying inflammation, redness and swelling of the joint. If the pain is not due to inflammation, acetaminophen is as effective as aspirin. It is as effective as the non-steroidal anti-inflammatory drug ibuprofen (Motrin) in relieving the pain of osteoarthritis of the knee.

DOSING: The oral dose for adults is 325 to 650 mg every 4-6 hours. The maximum daily dose is 4 grams. The oral dose for a child is based on the child's age, and the range is 40-650 mg every 4 hours.

When administered as a suppository, the adult dose is 650 mg every 4-6 hours. For children, the dose is 80-325 mg every 4-6 hours depending on age.

DRUG INTERACTIONS: Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen (e.g. carbamazepine, isoniazid, rifampin) may decrease the action of acetaminophen. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.

SIDE EFFECTS: When used appropriately, side effects are rare. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver.


GENERIC NAME: simvastatin

BRAND NAME: Zocor

DRUG CLASS AND MECHANISM: Simvastatin is a cholesterol- lowering medicine. It inhibits the production of cholesterol by the liver. It lowers overall blood cholesterol as well as blood LDL cholesterol levels. LDL cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the development of coronary artery disease. Lowering LDL cholesterol levels retards progression and may even reverse coronary artery disease.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: tablets: 5 mg,10 mg, 20 mg, 40 mg

STORAGE: Tablets should be stored at room temperature in a tightly closed container.

PRESCRIBED FOR: High blood cholesterol is first treated with exercise, weight loss, and a diet low in cholesterol and saturated fats. When these measures fail, cholesterol-lowering medications such as simvastatin can be added. The National Cholesterol Education Program (NCEP) has published treatment guidelines for use of these medications. These treatment guidelines take into account the level of LDL cholesterol as well as the presence of other risk factors such as diabetes, hypertension, cigarette smoking, low HDL cholesterol level, and family history of early coronary heart disease. The effectiveness of the medication in lowering cholesterol is dose related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made.

DOSING: May be taken on an empty or full stomach.

DRUG INTERACTIONS: Simvastatin is generally well- tolerated. The medication should be used with caution in patients with alcohol or other liver diseases. Persistently abnormal liver tests during treatment are rare, but may lead to a discontinuation of the medication. Rare cases of muscle inflammation (myositis) and breakdown have been reported with simvastatin. Muscle breakdown causes the release of muscle protein (myoglobin) into the blood and kidney tubules, resulting in acute kidney failure. The risk of muscle breakdown is increased when simvastatin is given together with other medications such as cyclosporine (Sandimmune), gemfibrozil (Lopid), erythromycin and nicotinic acid. Simvastatin may interact with cholestyramine (Questran), warfarin (Coumadin), and cimetidine (Tagamet) to alter the blood levels of these medicines. When Coumadin is given together with simvastatin, blood clotting times require monitoring to avoid excessive blood thinning and bleeding. Simvastatin should not be used in children. Simvastatin is not habit forming.

SIDE EFFECTS: Simvastatin is generally well-tolerated and side effects are rare. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Major side effects include abdominal pain or cramps, blurred vision, dizziness, easy bruising or bleeding, itching, muscle pain or cramps, rash, and yellowing of the skin or eyes.


GENERIC NAME: sertraline

BRAND NAME: Zoloft

DRUG CLASS AND MECHANISM: Sertraline belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRI). Other drugs in this class are Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram) and Luvox (fluvoxamine). Serotonin is a neurotransmitter (a chemical messenger) produced by nerve cells in the brain that is used by the nerves to communicate with one another. A nerve releases the serotonin it produces into the space surrounding it. The serotonin either travels across the space and attaches to receptors on the surface of nearby nerves or it attaches to receptors on the surface of the nerve that produced it, to be taken up by the nerve and released again (a process referred to as re-uptake). A balance is reached for serotonin between attachment to the nearby nerves and reuptake. Selective serotonin inhibitors block the reuptake of serotonin and therefore change the level of serotonin in the brain. It is believed that some illnesses such as depression are caused by disturbances in the balance between serotonin and other neurotransmitters. The leading theory is that drugs such as sertraline restore the chemical balance among neurotransmitters in the brain. Sertraline was approved by the Food and Drug Administration in December, 1991.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets: 25, 50, and 100 mg; oral concentrate: 20 mg/ml

STORAGE: Store at room temperature between 15-30°C (59-86°F).

PRESCRIBED FOR: Sertraline is a drug that is used to treat depression, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. Like other SSRIs, sertraline also is used for treating social anxiety disorder and postmenstrual dysphoric disorder.

DOSING: The recommended dose of sertraline is 25-200 mg once daily. Treatment usually is started at 25-50 once daily and then increased at weekly intervals until the desired response is seen. Sertraline may be taken with or without food.

DRUG INTERACTIONS: Serious reactions such as hyperthermia, fluctuations in blood pressure and rigidity of muscles may occur when SSRIs are used in combination with monoamine oxidase inhibitors (MAOI) such as phenelzine, tranylcypromine (Parnate) and isocarboxazid. Therefore, SSRIs should not be used in combination with MAOIs. In addition, SSRIs and MAOIs should not be used within 14 days of each other.

Cimetidine may increase the levels in blood of sertraline by reducing the elimination of sertraline by the liver. Increased levels of sertraline may lead to more side effects.

Sertraline increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and sertraline.

Through unknown mechanisms, sertraline may increase the blood thinning action of warfarin. The effect of warfarin should be monitored when sertraline is started or stopped.

SIDE EFFECTS: The most common side effects of sertraline are sleepiness, nervousness, insomnia, dizziness, nausea, tremor, skin rash, upset stomach, loss of appetite, headache, diarrhea, abnormal ejaculation, dry mouth and weight loss. Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder.

If sertraline is discontinued abruptly, some patients experience symptoms such as abdominal cramps, flu like symptoms, fatigue and memory impairment. Although this reaction is not well established, it is reasonable to gradually reduce the dose when therapy is discontinued.

It has been suggested that SSRIs may cause depression to worsen and even lead to suicide in a small number of patients. These potential side effects are difficult to evaluate in depressed patients because depression can progress with or without treatment, and suicide is itself a consequence of depression. Moreover, the evidence supporting these potential side effects is weak. Therefore, no conclusions can yet be drawn about the relationship between SSRIs and worsening depression and suicide. Until better information is available, patients receiving SSRIs should be monitored for worsening depression and suicidal tendencies.


GENERIC NAME: CETIRIZINE - ORAL TABLET (set-EYE-rizz-een)

BRAND NAME(S): Zyrtec

USES: This medication is an antihistamine which provides relief of seasonal and perennial allergy symptoms such as watery eyes, runny nose (rhinitis), itching eyes, and sneezing. It is also used for hives.

HOW TO USE: Take this medication by mouth once a day; or use as directed by your doctor. This drug may be taken with or without food. The chewable tablet form of this medication may be taken with or without water. Do not increase your dose or take this more often than directed. Do not take this medication for several days before allergy testing since test results can be affected.

SIDE EFFECTS: Drowsiness, fatigue and dry mouth may occur. In children, stomach pain and vomiting may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Tell your doctor immediately if any of these unlikely but serious side effects occur: yellowing eyes or skin, dark urine, persistent fatigue. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before taking cetirizine, tell your doctor or pharmacist if you are allergic to it; or to hydroxyzine; or if you have any other allergies. Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease. This drug may make you drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the drowsiness effect.

DRUG INTERACTIONS: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of drugs that cause drowsiness such as: anti-anxiety drugs (e.g., diazepam), other antihistamines that cause drowsiness (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep (e.g., sedatives), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine, or tricyclics such as amitriptyline), tranquilizers. Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: severe drowsiness. In children, symptoms may include initial restlessness and irritability followed by drowsiness.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854- 1166 (USA) or 1-800-668-1507 (Canada).


 

 

 

April 14, 2007 Senior. Horz.

 

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