Pregnancy Categories

Category A Definition Human studies show no risk in pregnancy.

B

No evidence of risk in humans, presumed safe because of animal studies.

C

Possible risk, uncertain safety, animal and human studies are lacking.

D

Positive risk, unsafe, but potential benefits may outweigh potential risks.

X

Contraindicated in pregnancy, highly unsafe.

Pregnancy Category X Drugs
y y y y y y y y y y y y y y Alcohol Androgens Cocaine Warfarin (Coumadin) Diethylstilbestrol Penicillamine (Cuprimine) Isotretinoin (Accutane) Live vaccines (Rubella) ³Statins´- HMG-CoA reductase inhibitors (Lipitor, etc.) Dutasteride (Avodart) Finasteride (Proscar, Propecia) Misoprostol (Cytotec) Iodides Thalidomide (Thalomid)

Drugs that cause Photosensitivity
Drug Category Antihistamine/Phenothiazine Antibiotics Antifungals Cardiovasculars Drug Phenergan (Promethazine) Cipro (Ciprofloxacin), Levaquin (Levofloxacin), Tetracycline, Minocycline, Doxycycline, Bactrim Griseofulvin Thiazide diuretics (Chlorthalidone, HCTZ, Indapamide), Loop diuretics (Furosemide), Cordarone (Amiodarone) Thorazine (Chlorpromazine) Accutane (Isotretinoin)

Antipsychotics Antiacne

Quick Facts y Photosensitivity is also called phototoxicity. y Reaction usually occurs rapidly and appears as sunburn. y Reaction can be prevented by limiting exposure to sunlight and/or by applying sunscreens.

Drugs that Discolor the Urine
Drug Pyridium (phenazopyridine) Vitamin B2 (riboflavin) Rifadin (rifampin) Urised (contains methylene blue) Color Red-Orange or Red-Brown Yellow Red or Pink Blue

Drugs Requiring Refrigeration

Xalatan Abelcet Avonex Anectine (Succinylcholine) Bay Hep B Bicillin CR, LA (Penicillin G) Byetta Cardizem injection (Diltiazem) Combipatch Calcitonin injection Desmopressin nasal (DDAVP) Duac topical gel Enbrel Engerix-B Epogen Intron A Lactinex Leukeran Ativan (Lorazepam injection) Marinol Methergine injection Miacalcin nasal spray Muse Neupogen injection Orapred Foradil Nuvaring PEG-Intron injection Procrit injection Phenergan suppositories Rebif injection Synagis injection Thyrolar

Insulins (Humulin/Novolin R, NPH, 70/30, U, Lantus, Humalog, Novolog) Vaccines (DTP-diptheria, tetanus, pertussis; HepB-hepatitis; MMR-measles, mumps, rubella)

Drug Storage Temperatures
Temperature Description Freezer Refrigerated Cool Room Temperature Warm Excess Heat Fahrenheit -4 to 14 degrees 36 to 46 degrees 46 to 59 degrees 59 to 86 degrees 86 to 104 degrees Above 104 degrees Celcius -20 to -10 degrees 2 to 8 degrees 8 to 15 degrees 15 to 30 degrees 30 to 40 degrees Above 40 degrees

Vitamins
Common Name Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B5 Vitamin B6 Chemical Name Retinol Ergocalciferol Tocopherol Phytonadione Thiamine Riboflavin Niacin Pantothenic Acid Pyridoxine Category Fat soluble Fat soluble Fat soluble Fat soluble Water soluble Water soluble Water soluble Water soluble Water soluble Use and/or Function Eyes (retinas)/ Antioxidant Bone weakness/Rickets Antioxidant Blood clotting Carbohydrate metabolism/Beriberi Mucous membranes Lipid metabolism Metabolism/coenzyme Metabolism of carbohydrates, proteins, fats Red blood cell production Anemia/red blood cell production Tissue repair, collagen formation/Scurvy

Vitamin B9 Vitamin B12 Vitamin C

Folic Acid Cyanocobalamin Ascorbic Acid

Water soluble Water soluble Water soluble

Quick Facts y Fat soluble vitamins = Vitamins A, D, E, K. y Antioxidant vitamins = Vitamins A, C, E. y Niacin causes red facial flushing. y Vitamin B6 (Pyridoxine) is given in combination with Isoniazid (INH) for tuberculosis treatment. y Vitamin B9 (Folic Acid) is given in combination with Methotrexate (MTX). y Vitamin K (Phytonadione) can be given to an overdosed Coumadin (Warfarin) patient. y Vitamin D (Ergocalciferol) is given with calcium supplements to increase the absorption of calcium. y Vitamin C (Ascorbic Acid) is given with iron supplements to increase the absorption of iron. y Vitamin E (Tocopherol) is given as an antioxidant.

Antidotes
Antidote Acetylcycsteine (Mucomyst) Atropine Deferoxamine Ethanol Flumazenil (Romazicon) Glucagon Leucovorin (Wellcovorin) Naloxone (Narcan) Pralidoxime (2-PAM, Protopam) Phytonadione (Vitamin K1) Protamine Poison Acetaminophen (Tylenol) Insecticides/mushrooms Iron Ethylene glycol/methanol Benzodiazepines (Valium, Xanax, etc.) Hypoglycemia (excess insulin usage) Methotrexate Opiates (heroin, morphine, etc.) Insecticides Warfarin (Coumadin) Heparin

DRUG CLASSIFICATION BY PREFIX OR SUFFIX
This table is an extremely important part of this book. In my teaching experience, students often get overwhelmed with the number of drugs in the pharmacy. At first glance, it seems impossible to learn all of the brand and generic drug names. This process can be made much easier by learning the prefixes and suffixes of common drugs dispensed. For example, if it is known that ³statin´ drugs are used to treat hyperlipidemia (high cholesterol), then it would be obvious that Simvastatin, Pravastatin and Lovastatin are all drugs that can be given to lower cholesterol.

Quick Drug Classification by Prefix or Suffix
Suffix or Prefix Drug Category Antibiotic Class or Action Macrolides Brand Biaxin®, Biaxin XL® Ery-Tab®, E-mycin® Ketek® Zithromycin®, Zmax® Minocin®, Dynacin® Sumycin® Vibramycin®, Adoxa®, Doryx®, Monodox®, Periostat® Avelox® Cipro® Factive® Floxin® Levaquin® Tequin® Ceclor® Cedax® Ceftin® Cefzil® Duricef® Keflex® Omnicef® Spectracef® Suprax® Vantin® Amoxil®, Trimox® Dynapen® Pen Vee K®, Veetids® Principen® Denavir® Famvir® Valcyte® Valtrex® Zovirax® Generic clarithromycin erythromycin telithromycin azithromycin minocycline tetracycline doxycycline moxifloxacin ciprofloxacin gemifloxacin ofloxacin levofloxacin gatifloxacin cephalor ceftibuten cefuroxime cefprozil cefadroxil cephalexin cefdinir cefditoren cefixime cefpodoxime amoxicillin dicloxacillin penicillin V ampicillin penciclovir famciclovir valganciclovir valacyclovir acyclovir

-mycin

-cycline

Antibiotic

Tetracyclines

-floxacin

Antibiotic

Fluoroquinolones

ceph-, cef-

Antibiotic

Cephalosporins

-cillin

Antibiotic

Penicillins

-cyclovir

Antiviral

Anti-Herpetics

-pril

Antihypertensive

Angiotensin Converting EnzymeInhibitors (ACEI¶s)

-sartan

Antihypertensive

Angiotensin II Receptor- Blockers (ARB¶s)

-osin

Antihypertensive, Benign Prostatic Hyperplasia (BPH)

1-Receptor Blockers

-olol

Antihypertensive

Cardioselective -Receptor Blockers

Nonselective

-Receptor Blockers

ISA (Intrinsic Sympathomimetic Activity)

Mixed

& -Receptor Blockers

-dipine

Antihypertensive

Calcium Channel Blockers (CCB¶s)

Accupril® Aceon® Altace® Capoten® Lotensin® Mavik® Monopril® Prinivil®, Zestril® Univasc® Vasotec® Atacand® Avapro® Benicar® Cozaar® Diovan® Micardis® Teveten® Cardura® Flomax® Hytrin® Minipress® Uroxatral® Kerlone® Lopressor® Tenormin® Toprol XL® Zebeta® Blocadren® Inderal® Corgard® Cartrol® Levatol® Sectral® Visken® Coreg® Trandate®, Normodyne® Adalat CC®, Procardia XL® Cardene® DynaCirc® Norvasc® Plendil® Sular®

quinapril perindopril ramipril captopril benazepril trandolapril fosinopril lisinopril moexipril enalapril candesartan irbesartan olmesartan losartan valsartan telmisartan eprosartan doxazosin tamsulosin terazosin prazosin alfuzosin betaxolol metoprololtartrate atenolol metoprololsuccinate bisoprolol timolol propranolol nadolol carteolol penbutolol acebutolol pindolol carvedilol labetalol nifedipine nicardipine isradipine amlodipine felodipine nisoldipine

-statin

Antihyperlipidemia

HMG-CoA Reductase Inhibitors

-glitazone Antidiabetic -glinide -dronate -tidine
Antidiabetic Osteoporosis

Thiazolidinediones Meglitinides Bisphosphonates

Anti-ulcer

H2-Receptor Antagonists

-prazole

Anti-ulcer

Proton Pump Inhibitors (PPI¶s)

-triptan

Anti-migraine

5-HT1 Receptor Antagonists (Triptan¶s)

-pam, -lam

Anti-anxiety/ Hypnotics

Benzodiazepines (BZD¶s)

-pramine

Antidepressants

Tricyclic Antidepressants (TCA¶s)

-triptyline Antidepressants -ine
Antidepressants

Tricyclic Antidepressants (TCA¶s)

Selective Serotonin Reuptake Inhibitors (SSRI¶s)

Crestor® Lescol® Lipitor® Mevacor® Pravachol® Zocor® Actos® Avandia® Prandin® Starlix® Actonel® Boniva® Fosamax® Axid® Pepcid® Tagamet® Zantac® Aciphex® Nexium® Prevacid® Prilosec® Protonix® Amerge® Axert® Frova® Imitrex® Maxalt® Relpax® Zomig® Ativan® Dalmane® Halcion® Klonopin® ProSom® Restoril® Serax® Valium® Xanax® Anafranil® Norpramin® Tofranil® Elavil® Pamelor® Vivactil® Paxil® Prozac® Zoloft®

rosuvastatin fluvastatin atorvastatin lovastatin pravastatin simvastatin pioglitazone rosiglitazone repaglinide nateglinide risedronate ibandronate alendronate nizatidine famotidine cimetidine ranitidine rabeprazole esomeprazole lansoprazole omeprazole pantoprazole naratriptan almotriptan frovatriptan sumatriptan rizatriptan eletriptan zolmitriptan lorazepam flurazepam triazolam clonazepam estazolam temazepam oxazepam diazepam alprazolam clomipramine desipramine imipramine amitriptyline nortriptyline protriptyline paroxetine fluoxetine sertraline

-one

Anti-inflammatory

Corticosteroids

-steride -nacin -fil -terol

Benign Prostatic Hyperplasia (BPH) Overactive Bladder and Incontinence Erectile Dysfunction

5 -Reductase Inhibitors Anticholinergics PDE5-Inhibitors

Pulmonary

-agonists

-mide, nide

-

Antihypertensive

Diuretics

Aristocort®, Kenalog® Celestone® Cortef®, Hydrocortone®, Solu-Cortef® Cortone® Decadron® Delta-Cortef®, Prelone®, Pediapred®, Orapred® Deltasone® Florinef® Solu-Medrol®, Medrol®, DepoMedrol® Avodart® Proscar® Enablex® Vesicare® Cialis® Levitra® Viagra® Foradil® Maxair® Proventil®, Ventolin®, Volmax® Serevent® Xopenex® Lasix® Bumex® Demadex® Lozol®

triamcinolone betamethasone hydrocortisone cortisone dexamethasone prednisolone prednisone fludrocortisone methylprednisolone dutasteride finasteride darifenacin Solifenacin tadalafil vardenafil sildenafil formoterol pirbuterol albuterol salmeterol levalbuterol furosemide bumetamide torsemide indapamide

Exception: y Clindamycin (Cleocin) is not a macrolide. It is a Lincomycin.

Practice Questions # 1
Match the drug class with a specific drug. A. Macrolide ___ 1. Temazepam B. Tetracycline ___ 2. Ranitidine C. Fluoroquinolone ___ 3. Starlix® D. Cephalosporin ___ 4. Pravastatin E. Penicillin ___ 5. Azithromycin F. Anti-Herpetic ___ 6. Ciprofloxacin G. ACE inhibitors ___ 7. Amoxicillin H. ARB ___ 8. Enalapril I. Alpha 1 receptor blocker ___ 9. Doxazosin J. Beta-blocker ___ 10. Felodipine K. Calcium channel blocker ___ 11. Avandia® L. HMG-CoA reductase inhibitor ___ 12. Minocycline M. Thiazolidinedione ___ 13. Zolmitriptan N. Meglitinide ___ 14. Cefadroxil O. Bisphosphonate ___ 15. Alendronate P. H2-Receptor antagonist ___ 16. Valacyclovir Q. 5-HT 1 receptor antagonist ___ 17. Irbesartan R. Benzodiazepine ___ 18. Bisoprolol Answers Practice Questions #1 1.R 2.P 3.N 4.L 5.A 6.C 7.E 8.G 9.I 10.K 11.M 12.B 13.Q 14.D 15.O 16.F 17.H 18.J

Practice Questions # 2
Match the drug class with the suffix or prefix. A. Macrolide ___ 1. -sartan B. Tetracycline ___ 2. -cyclovir C. Fluoroquinolone ___ 3. -dronate D. Cephalosporin ___ 4. -statin E. Penicillin ___ 5. -cillin F. Anti-Herpetic ___ 6. -tidine G. ACE inhibitors ___ 7. -dipine H. ARB ___ 8. -glinide I. Alpha 1 receptor blocker ___ 9. cephJ. Beta-blocker ___ 10. -triptan K. Calcium channel blocker ___ 11. -olol L. HMG-CoA reductase inhibitor ___ 12. -floxacin M. Thiazolidinedione ___ 13. -lam N. Meglitinide ___ 14. -osin O. Bisphosphonate ___ 15. -cycline P. H2-Receptor antagonist ___ 16. -glitazone Q. 5-HT 1 receptor antagonist ___ 17. -pril R. Benzodiazepine ___ 18. -mycin Answers Practice Questions # 2 1.H 2.F 3.O 4.L 5.E 6.P 7.K 8.N 9.D 10.Q 11.J 12.C 13.R 14.I 15.B 16.M 17.G 18.A

Practice Questions # 3
Match the drug category or disease state with a specific drug. (may use an answer multiple times) A. Hypertension ___ 1. Doxycycline ___ 16.Dutasteride B. Anti-Inflammatory ___ 2. Albuterol ___ 17. Simvastatin C. Antiviral ___ 3. Diazepam ___ 18.Nifedipine D. Pulmonary Disease ___ 4. Ranitidine ___ 19. Amoxicillin E. Benign Prostatic Hyperplasia ___ 5. Accupril ___ 20.Tamsulosin F. Antiulcer ___ 6. Amitriptyline ___ 21. Ciprofloxacin G. Antidepressant ___ 7. Fluoxetine ___ 22.Lansoprazole H. Antibiotic ___ 8. Clonazepam ___ 23. Hydrocortisone I. Hyperlipidemia ___ 9. Sumitriptan ___ 24. Alendronate J. Diabetes ___ 10. Clarithromycin K. Migraine ___ 11. Losartan L. Antianxiety ___ 12. Sildenafil M. Osteoporosis ___ 13. Darifenacin N. Incontinence ___ 14. Cefuroxime O. Erectile Dysfunction ___ 15. Atenolol

Answers Practice Questions # 3 1.H 2.D 3.L 4.F 5.A 6.G 7.G 8.L 9.K 10.H 11.A 12.O 13.N 14.H 15.A 16.E 17.I 18.A 19.H 20.E 21.H 22.F 23.B 24.M