PHARMACOLOGYDRUG LIST 14

MOD 200

A. JAMES

Immunomodulators

AVONEX Interferon beta 1a

COPAXONE glatiramer

TYSABRI natalizumab

AVONEX

Indication: multiple sclerosis Action: produced by mammalian cells

(Chinese hamster ovary cells) where the human interferon beta gene has been introduced. The exact mechanism of action is not understood, but it exhibits immunoregulatory activities.

Warnings: photosensitivity, abortifacient potential (Induces abortion). Report symptoms of depression.

Administration: for IM use only. Patient must be trained with proper technique. Dilute with supplied diluents and gently swirl. Use reconstituted solution within 6 hours.

COPAXONE

Indication: multiple sclerosis Action: unknown. It is thought to modify

immune processes that are thought to be responsible for the pathogenesis (step by step development of the disease) of MS.

Warnings: for SC injection only. Watch for injection site reactions. Keep refrigerated

Administration: allow dose to warm to room temperature (20mins). Visually inspect for particulate matter or discoloration. Return any syringes that contain solution with particulate matter or is discolored.

TYSABRI

Indication: multiple sclerosis what is MS or crohn’s disease

Action: a recombinant humanized IgG4x monoclonal antibody. Mechanism of action is not clearly understood.

Restriction: patients must be registered through the TOUCH prescribing program. An MRI scan prior to treatment initiation is recommended – to create a baseline

Black box warning: progressive multifocal leukoencephalopathy—an opportunistic viral infection of the brain. Check medwatch web site for updates on this.

Warnings: PML, hypersensitivity reactions, hepatotoxicity. Headache, arthralgia or fatigue.

Administration: do not use vials that contain particulate matter or are discolored. Dilute 15ml of concentrate into 100ml of NS. Do not shake. No other diluents is to be used. Again check for discoloration or particulate matter. Use immediately; may be stored up to 8 hours if refrigerated

NARCOTIC ANALGESIC

Indications: severe pain or pain management Action: the precise mechanism of analgesic

action of narcotic or opioid analgesics is unknown.

Naturally or synthetically based from opium/opium products

Warnings: black box warning concerning addiction potential and risk of respiratory depression (especially when used with other CNS depressants). Withdrawal severity is related to the degree of dependence, the abruptness of withdrawal and the drug used. Chronic pain patients who withdrawn from medication abruptly may experience a severe abstinence syndrome that is similar to heroin. Maintain fluids, use tranquilizers to reduce anxiety. Narcotic replacement with gradual withdrawal may minimize symptoms.

No alcohol, D/D, may cause constipation. Take with food.

Drug interactions: numerous especially with agents that also affect the CNS

 

Actiq/Duragesic/Sublimaze CII

Fentanyl Actiq: oral transmucosal lozenge to be

dissolved slowly in the mouth to be absorbed by the transmucousal tissues. The handle is there so that it can be easily removed if signs of excessive opioid effects happen during administration.

Use: breakthrough pain in cancer patients 16yrs and older. Not for use in patients who are opiate naive

Warning: only intended for the care of cancer patients and prescribed only by pain specialists

Duragesic: transdermal patch Use: for opioid tolerant patients to treat persistant

moderate to severe pain that requires around the clock administration for an extended amount of time.

Administration: patch lasts up to 72hrs. Apply patch to a clean dry area. If hair removal is necessary; it should be clipped not shaven. Follow proper procedure in removal and disposal of used patches.

Sublimaze: injection Use indicated for pain of short duration during

anesthesia and in the immediate post op period as needed. Also may be used as a supplement in general or regional anesthesia.

Warning: black box warning concerning respiratory depression or arrest. Patients must be closely monitored

DILAUDID CII

Hydromorphone: a hydrogenated ketone of morphine.

Use: in pain management when appropriate. Warning: first sign of tolerance is when it

doesn’t work well anymore. Accidental skin exposure by oral solution:

personnel should remove any contaminated clothing and rinse affected area with cool water

METHADOSE CII

Methadone: synthetic opioid

Indications: pain management, detoxification and temporary maintenance treatment of narcotic addiction

Warnings: black box for treatment use, respiratory and cardiac effects.

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&rgn=div5&view=text&node=42:1.0.1.1.9&idno=42 this page is federal code describing requirments for a treatment facility.

This medication was developed in Germany at the start of WWII in anticipation of disrupted opium supply. Wikipedia article covers this and rumors about the name dolophine.

MS CONTIN CII

Morphine sulfate extended release Indication: relief of moderate to severe pain in

patients requiring continuous opioid therapy for an extended period of time. Not intended for prn usage.

Other extended release forms include: Kadian, Avinza

Warnings: do not chew or crush, this may lead to rapid absorption to a potential fatal dose.

Notes about morphine in general: Morphine is the standard against which all other narcotics

are compared. Heroin (diacetylmorphine) was developed from morphine

and marketed by the Bayer drug company in 1898 Morphine was one of the first drugs controlled (Harrison

Narcotics Tax Act of 1914)

OXYCONTIN CII

Oxycodone extended release Indication: same as morphine Warnings: do not crush or chew, this may lead

to rapid absorption to a potentially fatal dosage.

Appropriate dosing of extended release products should be every 12 hours.

Notes about oxycodone in general: Developed in Germany as a replacement for heroin

in early 20th century In 2007, USA had the highest consumption world

wide at a staggering 51.6 tons! Washington State is considered one of the highest

for number of prescriptions and number of thefts of oxycodone and other narcotics

Narcotic analgesic combos

Indication: relief of mild to moderately severe pain

Action: narcotic action plus non non-narcotic action of ASA or APAP for increased analgesic effect.

Warnings: take with food, D/D, no alcohol. May cause constipation. Watch OTC usage for additive APAP dosing

Watch for potentially fatal hepatic necrosis and APAP overdose.

Current standard of 4gms maximum APAP daily.

Acetylcysteine may be indicated as an antidote for APAP. http://www.rxlist.com/tylenol-drug.htm gives overdose management information

TYLENOL/CODEINE #3 CIII

Acetaminophen/Codeine #3 Toxicity may result from codeine or APAP If hypoprothrombinemia* occurs with APAP

overdose, treat with IV vitamin K *blood disorder , impaired clotting (factor II)

VICODIN CII

Hydrocodone/APAP Use: moderate pain. May also be used as an

antitussive Watch APAP amounts Watch strength Generic tends to be #1 prescribed drug in USA Usual dosing = 1-2 q4-6h prn pain

ENDOCET/PERCOCET CII

Oxycodone/APAP Use moderate to mod. Severe pain. If used for more than a few weeks; taper

gradually to prevent symptoms of withdrawal. Watch the use of additional CNS depressants

( alcohol, other opioids)

DARVOCET CIV

Propoxyphene napsylate/APAP Use: mild to moderate pain. CIV Warning: metabolism of propoxyphene may be

altered by strong CYP3A4 inhibitors like ritonovir, -azole antifungals, grapefruit juice

Black box warning: major cause of drug related deaths. (medwatch has articles on this) http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm171714.htm . (article dated 7/09)

Non-narcotic analgesic

ULTRAM tramadol

Indications: non narcotic analgesic for management of moderate to moderately severe pain in adults 17yr and older.

Action: centrally acting analgesic not chemically related to opiates. Causes less respiratory depression than morphine. Exact mechanism of action is unknown.

Warnings: no alcohol, D/D. Drug interactions: MAOIs, carbamazepine,

cyclobenzaprine, digoxin, SSRIs, TCAs

BENZODIAZEPINES

Indications: antianxiety, anticonvulsants, sedative hypnotics, muscle relaxants

Action: appear to potentiate the effects of GABA by binding to specific benzodiazepine receptor sites.

Warnings: avoid alcohol, D/D. do not drink grapefruit juice. Prolonged use may lead to dependence.

XANAX CIV

Alprazolam Use: panic disorder, anxiety, depression Do not use with grapefruit juice, -azole

antifungals. Nicotine decreases effect of medication

Drug interactions: BCPs, phenytoin, -azole antifungals, digoxin, alcohol

Preg category D: may cause fetal harm

VALIUM CIV

Diazepam Use: anxiety, muscle relaxant Was given to sharpshooters during Vietnam conflict

to calm nerves and give them a steady hand. May also be used in acute alcohol withdrawal Anterograde amnesia* may occur while using it for

therapeutic dosages (* Anterograde amnesia is a loss of the ability to create memories after the event that caused the amnesia occurs)

Liver function tests are advisable for long term use

ATIVAN CIV

Lorazepam: Use: anxiety disorders, or short term anxiety

associated with depression, insomnia Not indicated for long term use Injection indicated for use in status epilepticus,

preanesthetic. Store refrigerated, protect from light

MISC. ANXIETY

BUSPAR Buspirone

Indication: short term use for anxiety. Off-label: reduce the symptoms of premenstrual syndrome

Action: MOA is unknown. It differs from typical benzodiazepines anxiolytics in that it does not exert anticonvulsant or muscle relaxant effects.

Warnings: D/D, avoid grapefruit juice Drug interactions: CYP 3A inhibitors (azole

antifungals, some anticonvulsants etc), MAOIs

SEDATIVE HYPNOTIC

DIPRIVAN Propofol

Indication: anesthesia Action: fast acting hypnotic agent (within 40 seconds) Warnings: only to be used by trained professional. Ability to

perform activities may be impaired for some time after anesthesia/sedation

Medication is more stable in glass than plastic. Medication is available as an injectable emulsion 

VERSED CIV

Midazolam Indication: sedation, anxiolysis, amnesia Action: short acting benzodiazepine CNS

depressant Warnings: black box concerning noncritical

care use. Patient must be monitored during use. To be used only by trained professionals. Drug is considered 3-4 times more potent than diazepam. Not for use on infants

ZEMURON

Rocuronium bromide Indication: facilitate intubation, provide

skeletal relaxation during surgery or mechanical ventilation (paralyzing agent)

Action: a nondepolarizing neuromuscular blocking agent with rapid to intermediate onset depending on dose and intermediate duration.

Warnings: to administered only by trained professionals. Patients must be monitored during use.

Drug interactions: anticonvulsants, lithium