Medicotion worksheet lo//2011

Gener|c Name]8rand Name

Io||c Ac|d]V|tam|n 8

Gener|c Name]8rand Name
Metform|n]G|ucophage
Dose] koute] Irequency Crdered
1 mg tab|et]Cra|]Da||y

Is th|s route appropr|ate for pat|ent? ?es /no
Dose] koute] Irequency Crdered
S00 mg tab|et]Cra|]8ID
Is th|s route appropr|ate for pat|ent? es ]No
n|gh A|ert? es ]No Why? n|gh A|ert? es ]No Why?
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
Ant|anem|cs v|tam|ns]Water so|ub|e v|tam|ns
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
Ant|d|abet|cs]8|guan|des
Act|on (therapeut|c effect)
kequ|red for prote|n synthes|s and red b|ood ce|| funct|on St|mu|ates
the product|on of k8C W8C and p|ate|ets Necessary for norma| feta|
deve|opment (kestorat|on and ma|ntenance of norma|
hematopo|es|s)
Act|on (therapeut|c effect)
Contro|s hyperg|ycem|a Decreases hepat|c g|ucose product|on
Decreases |ntest|na| g|ucose absorpt|on Increases sens|t|v|ty to
|nsu||n (Ma|ntenance of b|ood g|ucose)
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
revent|on and 1x of mega|ob|ast|c and macrocyt|c anem|as G|ven
dur|ng pregnancy to promote norma| feta| deve|opment
Why |s th|s person gett|ng th|s med|cat|on (Ind|cat|on)
Management of type 2 d|abetes me|||tus may be used w|th d|et
|nsu||n or su|fony|urea ora| hypog|ycem|c
nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)
Unknown
nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)
Unknown
harmacok|net|cs (onset peak durat|on metabo||sm)
Cnset 3060 m|n eak 1 hr Durat|on unknown Metabo||sm and
Lxcret|on Converted by the ||ver to |ts act|ve metabo||te
d|hydrofo|ate reductase Lxcess amounts are excreted unchanged by
the k|dneys
harmacok|net|cs (onset peak durat|on metabo||sm)
Cnset unknown eak unknown Durat|on 12 hr Metabo||sm and
Lxcret|on L||m|nated a|most ent|re|y unchanged by the k|dneys
1extbook Dose kange (for ordered route and |nd|cat|on)
C 1 mg]day |n|t|a| dose then 0S mg]day ma|ntenance dose
1extbook Dose kange (for ordered route and |nd|cat|on)
C (Adu|ts and Ch||dren 17 yr) S00 mg tw|ce da||y may |ncrease by
S00 mg at week|y |nterva|s up to 2000 mg]day If doses 2000 mg]day
are requ|red g|ve |n 3 d|v|ded doses (not to exceed 2S00 mg]day) or
8S0 mg once da||y may |ncrease by 8S0 mg at 2wk |nterva|s (|n
d|v|ded doses) up to 2SS0 mg]day |n d|v|ded doses (up to 8S0 mg 3
t|mes da||y)
Contra|nd|cat|ons]Caut|ous use
Uncorrected pern|c|ous ap|ast|c or normocyt|c anem|as]Und|agnosed
anem|as
Contra|nd|cat|ons]Caut|ous use
nypersens|t|v|ty Metabo||c ac|dos|s Dehydrat|on seps|s hypoxem|a
hepat|c |mpa|rment excess|ve a|coho| use kena| dysfunct|on
kad|ograph|c stud|es requ|r|ng IV |od|nated contrast med|a
CnI]Concurrent rena| d|sease Ger| Ger|atr|c or deb|||tated pt (Avo|d
|n 80 yr un|ess rena| funct|on |s norma|) Chron|c a|coho| use or abuse
Ser|ous med|ca| cond|t|ons t undergo|ng stress nypox|a |tu|tary
def|c|ency or hyperthyro|d|sm
Adverse keact|on
Common No symptoms


Severe No symptoms


1ox|c|ty s|gns]Cverdose Ant|dote? No symptoms]No ant|dote

Adverse keact|on
Common Abdom|na| b|oat|ng d|arrhea and N]V


Severe Lact|c Ac|dos|s (?)


1ox|c|ty s|gns]Cverdose Ant|dote? No symptoms]No ant|dote
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
Do not confuse fo||c ac|d w|th fo||n|c ac|d C Antac|ds shou|d be g|ven
at |east 2 hr after fo||c ac|d fo||c ac|d shou|d be g|ven 2 hr before or 46
hr after cho|estyram|ne A S0 mcg]mL ora| so|ut|on may be
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
t staba||zed on a d|abet|c reg|men who are exposed to stress fever
trauma |nfect|on or surgery may requ|re adm|n|strat|on of |nsu||n
W|thho|d metform|n and re|nst|tute after reso|ut|on of acute ep|sode
extemporaneous|y prepared by pharmacy for use |n neonates and
|nfants Ioods h|gh |n fo||c ac|d |nc|ude vegetab|es fru|ts and organ
meats heat destroys fo||c ac|d |n foods May make ur|ne more
|ntense|y ye||ow Not|fy phys|c|an |f rash occurs wh|ch may |nd|cate
hypersens|t|v|ty
Metform|n shou|d be temp d|scont|nued |n pt requ|r|ng surgery
|nvo|v|ng restr|cted |ntake of food and f|u|ds kesume when ora| |ntake
has resumed and rena| fx |s norma| W|thho|d before or at the t|me of
stud|es requ|r|ng IV adm|n|strat|on of |od|nated contrast med|a and for
48 hr after study Adm|n|ster w|th mea|s to m|n GI effects Instruct to
take at same t|me each day kev|ew s|gns of hypog|ycem|a and
hyperg|ycem|a w|th pt If hypog|ycem|a occurs adv|se pt to take a
g|ass of CI or 23 tsp of sugar honey or corn syrup d|sso|ved |n water
and not|fy phys|c|an Instruct pt |n proper test|ng of b|ood g|ucose and
ur|ne keytones espec|a||y dur|ng stress or |||ness Lxp|a|n to pt the r|sk
of |act|c ac|dos|s and the potent|a| need for d|scont|nuat|on |f a severe
|nfect|on dehydrat|on or severe or cont|nu|ng d|arrhea occurs or |f
med|ca| tests or surgery |s requ|red Symptoms are ch|||s d|arrhea
d|zz|ness |ow b|ood pressure musc|e pa|n s|eep|ness s|ow heartbeat
or pu|se dyspnea or weakness Warm pt |t may cause an unp|easant
or meta|||c taste that usua||y reso|ves spontaneous|y Adv|se pt to
carry a form of sugar and |dent|f|cat|on
Assessment needed (pre dur|ng and post)
Assess pt for s|gns of mega|ob|ast|c anem|a (fat|gue weakness
dyspnea) before and per|od|ca||y throughout therapy Lab 1ests
Mon|tor p|asma fo||c ac|d |eve|s hemog|ob|n hematocr|t and
ret|cu|ocyte count before and per|od|ca||y dur|ng therapy May cause
decrease serum concentrat|ons of other 8 comp|ex v|tam|ns when
g|ven |n h|gh cont|nuous doses
Assessment needed (pre dur|ng and post)
When comb|ned w|th ora| su|fony|ureas observe for s|gns and
symptoms of hypog|ycem|c react|ons (abd a|n sweat|ng hunger
weakness d|zz|ness n]A tremor tachycard|a anx|ety) t who have
been we|| contro||ed on metform|n who deve|op |||ness or |aboratory
abnorma||t|es shou|d be assessed for ketoac|dos|s or |act|c ac|dos|s
Assess serum e|ectro|ytes ketones g|ucose and |f |nd|cated b|ood
pn |actate pyruvate and metform|n |eve|s If e|ther form of ac|dos|s |s
present d|scont|nue metform|n |mmed|ate|y and treat ac|dos|s Lab
1ests Mon|tor serum g|ucose and g|ycosated hemog|ob|n per|od|ca||y
dur|ng therapy to eva|uate effect|veness of therapy May cause fa|se
pos|t|ve resu|ts for ur|ne keytones Mon|tor b|ood g|ucose
concentrat|ons rout|ne|y by pt and every 3 mo by profess|ona|s to
determ|ne effect|veness Assess rena| fx before therapy and at |east
annua||y dur|ng therapy Mon|tor serum fo||c ac|d and v|tam|n 812
every 12 yr |n |ongterm therapy Metform|n may |nterfere w|th
absorpt|on
keference(s)
Dav|s Drug Gu|de 12
th
Ld|t|on pp 606607
keference(s)
Dav|s Drug Gu|de 12
th
Ld|t|on pp 829830


Medicotion worksheet lo//2011
Gener|c Name]8rand Name
Cmeprazo|e (omeprazo|e)]r||osec
Gener|c Name]8rand Name
nMGCoA kLDUC1ASL INnI8I1CkS (Stat|ns)
S|mvastat|n (s|mvastat|n)]2ocor
Dose] koute] Irequency Crdered
20 mg capsu|e]Cra|]Cnce da||y before mea|s
Is th|s route appropr|ate for pat|ent? ?es /no
Dose] koute] Irequency Crdered
10 mg tab|et]Cra|]8edt|me
Is th|s route appropr|ate for pat|ent? ?es /no
n|gh A|ert? es ]No Why? n|gh A|ert? es ]No Why?
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
Ant|u|cer agents]rotonpump |nh|b|tors
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
L|p|d|ower|ng agent]nMGCoA reductase |nh|b|tors
Act|on (therapeut|c effect)
8|nds to an enzyme on gastr|c par|eta| ce||s |n the presence of ac|d|c
gastr|c pn prevent|ng the f|na| transport of hydrogen |ons |nto the
gastr|c |umen (D|m|n|shed accumu|at|on of ac|d |n the gastr|c |umen
w|th |essened gastroesophagea| ref|ux nea||ng of duodena| u|cers
Act|on (therapeut|c effect)
Inh|b|t an enzyme 3hydroxy3methy|gutary|coenzyme A (nMG
CoA) reductase wh|ch |s respons|b|e for cata|yz|ng an ear|y step |n the
synthes|s of cho|estero| (Lowers tota| and LDL cho|estero| and
tr|gy|cer|des S||ght|y |ncrease nDL S|ows the progress|on of coronary
atherosc|eros|s w|th resu|tant decrease |n CnDre|ated events (a||
agents except rosuvastat|n have |nd|cat|on for decrease events)
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
GLkD]ma|ntenance of hea||ng |n eros|ve esophag|t|s Duodena| u|cers
(w|th or w|thout ant||nfect|ves for ne||cobacter py|or|) Shortterm 1x
of act|ve ben|gn gastr|c u|cer atho|og|c hypersecretory cond|t|ons
|nc|ud|ng 2o|||ngerL|||son syndrome keduct|on of r|sk of GI b|eed|ng |n
cr|t|ca||y ||| pt C1C heartburn occurr|ng tw|ce]wk
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
Secondary prevent|on of card|ovascu|ar events (decrease r|sk of MI
coronary revascu|ar|zat|on stroke and card|ovascu|ar morta||ty) |n pt
w|th c||n|ca||y ev|dent CnD or those at h|ghr|sk for CnD (h|story of
d|abetes per|phera| arter|a| d|sease or stroke)
nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)
Unknown

nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)

harmacok|net|cs (onset peak durat|on metabo||sm)
Cnset w|th|n 1 hr eak w|th|n 2 hr Durat|on 7296 hr Metabo||sm
||ver
harmacok|net|cs (onset peak durat|on metabo||sm)
Cnset severa| days eak 24 wk Durat|on unknown Metabo||sm
L|ver
1extbook Dose kange (for ordered route and |nd|cat|on)
C (Adu|ts) GLkD]eros|ve esophag|t|s 20 mg once da||y
1extbook Dose kange (for ordered route and |nd|cat|on)
C (Adu|ts) S80 mg once da||y |n the even|ng kena| Impa|rment C
(Adu|ts) CCr10 mL]m|n S mg]day |n|t|a||y t|trate carefu||y
Contra|nd|cat|ons]Caut|ous use
nypersens|t|v|ty]L|ver d|sease
Contra|nd|cat|ons]Caut|ous use
nypersens|t|v|ty Act|ve ||ver d|sease or unexp|a|ned pers|stant
|ncrease |n AS1 or AL1 Concurrent use of gemf|broz|| or azo|e
ant|funga|s macro||des protease |nh|b|tors n|ac|n cyc|ospor|ne
am|odarone or verapam|| Concurrent use of ne|f|nav|r or
r|tonav|r]n|story of ||ver d|sease A|coho||sm
Adverse keact|on
Common Abdom|na| a|n


Severe No symptoms


1ox|c|ty s|gns]Cverdose Ant|dote? No symptoms]No ant|dote

Adverse keact|on
Common Abdom|na| cramps const|pat|on d|arrhea f|atus heartburn
and rashes

Severe khabdomyo|ys|s (?)


1ox|c|ty s|gns]Cverdose Ant|dote? No symptoms]No ant|dote

Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
Do not confuse w|th r|n|v|| (||s|nopr||) C Adm|n|ster doses before
mea|s preferab|y |n the AM Shou|d be swa||owed who|e do not crush
or chew Capsu|es may be opened and spr|nk|ed on coo| app|esauce
ent|re m|xture shou|d be |ngested |mmed|ate|y and fo||owed by a dr|nk
of water Do not store for future use May be adm|n|stered
concurrent|y w|th other antac|ds May cause occas|ona| drows|ness or
d|zz|ness Avo|d a|coho| products conta|n|ng asp|r|n or NSAIDS and
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
Adm|n|ster extended re|ease tab|ets at bedt|me 1hey shou|d be
swa||owed who|e do not break crush or chew Adm|n|ster 2ocor once
da||y |n the M Avo|d |arge amounts of grapefru|t [u|ce dur|ng
therapy may |ncrease r|sk of tox|c|ty Adv|se pt that th|s med Shou|d
be used |n con[unct|on w|th d|et restr|ct|ons (fat cho|estero| carbs
a|coho|) exerc|se and cessat|on of smok|ng Not|fy phys|c|an |f
unexp|a|ned musc|e pa|n tenderness or weakness occurs espec|a||y |f
foods that may cause an |ncrease |n GI |rr|tat|on keport onset of b|ack
tarry stoo|s d|arrhea abd a|n or pers|stant n]A
accompan|ed by fever or ma|a|se
Assessment needed (pre dur|ng and post)
Assess pt rout|ne|y for ep|gastr|c or abd a|n and frank or occu|t
b|ood |n the stoo| emes|s or gastr|c asp|rate Lab 1ests Mon|tor C8C
w|th d|fferent|a| per|od|ca||y dur|ng therapy May cause |ncrease AS1
AL1 a|ka||ne phosphatase and b|||rub|n May cause serum gastr|n
concentrat|ons to |ncrease dur|ng f|rst 12 wk of therapy Leve|s return
to norma| after d|scont|nuat|on of med Mon|tor INk and prothromb|n
t|me |n pt tak|ng warfar|n
Assessment needed (pre dur|ng and post)
Cbta|n a d|etary h|story espec|a||y w|th regard to fat consumpt|on
Lab 1ests Lva|uate serum cho|estero| and tr|g|ycer|de |eve|s before
|n|t|at|ng after 46 wk of therapy and per|od|ca||y thereafter Mon|tor
||ver fx tests |nc|ud|ng AS1 before at 12 wk after |n|t|at|on of therapy
or after dose e|evat|on and then q 6 mo If AS1 |eve|s |ncrease to 3
t|mes norma| nMGCoA reductase |nh|b|tor therapy shou|d be
reduced or d|scont|nued May a|so cause |ncrease a|ka||ne
phosphatase and b|||rub|n |eve|s If pt deve|ops musc|e tenderness
dur|ng therapy mon|tor Ck |eve|s If Ck |eve|s are 10 t|mes the upper
||m|t of norma| or myopathy occurs therapy shou|d be d|scont|nued
keference(s)
Dav|s Drug Gu|de 12
th
Ld|t|on pp 9S09S1
keference(s)
Dav|s Drug Gu|de 12
th
Ld|t|on pp 666669