Pharmacy Communications I

Albuterol Trade Name

Top 200 Drugs: List 5

Available Forms

Therapeutic Class MoA Indications Contraindications Relative CIs

Dose Adjustments Pregnancy Category Lactation Use Instructions for Use

Storage Instructions Drug Interactions

ADRs > 10%

AccuNeb ProAir HFA Proventil HFA Ventolin HFA VoSpire ER Aerosol, for oral inhalation: Injection, solution Solution for nebulization [preservative free] Syrup, oral Tablet, oral Tablet, extended release Beta 2 Agonist Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate Bronchodilator in reversible airway obstruction due to asthma or COPD Prevention of exercise-induced bronchospasm Hypersensitivity to albuterol, adrenergic amines, or any component of formulation Appropriate use: Do not exceed recommended dose; serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics. Patient information: Patients must be instructed to seek medical attention in cases where acute symptoms are not relieved or a previous level of response is diminished. The need to increase frequency of use may indicate deterioration of asthma, and treatment must not be delayed. A spacer device or valved holding chamber is recommended when using a metered-dose inhaler. Renal: Not removed by HD (hemodialysis) C unknown/use caution IV Infusion solution (Ventolin I.V.): Do not inject undiluted. Reduce concentration by at least 50% before infusing. Administer as a continuous infusion via infusion pump. Discard unused portion of infusion within 24 hours of preparation. Administration: Oral: Do not crush or chew extended release tablets. Administer with water 1 hour before or 2 hours after meals. Administration: Inhalation: Metered-dose inhaler: Shake well before use; prime prior to first use, and whenever inhaler has not been used for >2 weeks or when it has been dropped, by releasing 3-4 test sprays into the air (away from face). A spacer device or valved holding chamber is recommended for use with metered-dose inhalers. Solution for nebulization: Concentrated solution should be diluted prior to use. Blow-by administration is not recommended, use a mask device if patient unable to hold mouthpiece in mouth for administration. Food: Avoid or limit caffeine (may cause CNS stimulation). Herb/Nutraceutical: Avoid ephedra, yohimbe (may cause CNS stimulation). Avoid St John's wort (may decrease the levels/effects of albuterol). Ventolin HFA (aerosol): Discard after using 200 actuations or 3 months after removal from protective pouch, whichever comes first. Store with mouthpiece down. AccuNeb (solution for nebulization): Store at 2C to 25C (36F to 77F). Do not use if solution changes color or becomes cloudy. Use within 1 week of opening foil pouch. Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X Alpha-/Beta-Blockers: May diminish the therapeutic effect of Beta2-Agonists. Risk D Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Risk D % Not reported

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Pharmacy Communications I
Azithromycin Trade Name Available Forms

Top 200 Drugs: List 5

Therapeutic Class MoA Indications

Contraindications Dose Adjustments Pregnancy Category Lactation Use Storage Instructions

Instructions for Use

Drug Interactions

ADRs > 10%

AzaSite, Zithromax, Zmax Injection, powder for reconstitution Microspheres for oral suspension, extended release Powder for oral suspension Solution, ophthalmic Tablet Antibiotic, Macrolide; Antibiotic, Ophthalmic Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation Oral, I.V.: o Treatment of acute otitis media due to (H. influenza, M. catarrhalis, S. pneumonia) o pharyngitis/tonsillitis due to S. pyogenes o treatment of mild-to-moderate upper and lower respiratory tract infections, infections of the skin and skin structure, community-acquired pneumonia, pelvic inflammatory disease (PID), sexually-transmitted diseases (urethritis/cervicitis), pharyngitis/tonsillitis (alternative to first-line therapy), and genital ulcer disease (chancroid) due to susceptible strains of Chlamydophila pneumonia H. influenza Mycoplasma pneumonia C. trachomatis S. aureus C. psittaci M. catarrhalis S. pneumonia o acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD) due to H. influenzae, M. catarrhalis, or S. pneumoniae; acute bacterial sinusitis Ophthalmic: Bacterial conjunctivitis Drug of Choice or Alternative for Disease Drug of Choice or Alternative for Organism(s) Bronchitis Babesia microti Cervicitis Bordetella pertussis Erysipelas Chlamydophila pneumoniae Pneumonia, Community-Acquired Haemophilus ducreyi Traveler's Diarrhea Legionella pneumophila Urethritis, Nongonococcal Moraxella catarrhalis Mycobacterium avium-intracellulare (Complex) Mycobacterium kansasii Mycoplasma pneumoniae Ureaplasma urealyticum Hypersensitivity to azithromycin, other macrolide (eg, azalide or ketolide) antibiotics, or any component of the formulation Renal Impairment: Caution in patients with GFR <10 mL/minute Hepatic Impairment: Caution potential for hepatotoxicity (rare). No specific guidelines. B Enters breast milk/use caution Injection: Reconstituted solution is stable for 24 hours when stored below 30C. Ophthalmic solution: Prior to use, store unopened under refrigeration. After opening, discard any remaining solution after 14 days. Suspension, XR: Do not refrigerate or freeze. Consume within 12 hours following reconstitution. Food: Rate and extent of GI absorption may be altered depending upon the formulation. Azithromycin suspension, not tablet form, has significantly increased absorption (46%) with food. Oral suspension, immediate release, may be administered with or without food. Oral suspension, extended release, should be taken on an empty stomach (at least 1 hour before or 2 hours following a meal). Tablet may be administered with food to decrease GI effects. Risk X: Risk D: Pimozide Artemether Amiodarone QuiNINE Dronedarone Cardiac Glycosides Tetrabenazine Lumefantrine Gadobutrol Thioridazine Nilotinib Typhoid Vaccine Ziprasidone Gastrointestinal: Diarrhea, nausea

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Pharmacy Communications I
Clindamycin Trade Name Available Forms

Top 200 Drugs: List 5

Therapeutic Class MoA Indications

Contraindications

Relative CIs Dose Adjustments Pregnancy Category Lactation Use Storage Instructions

Instructions for Use

Drug Interactions

ADRs > 10%

Cleocin HCl; Cleocin Pediatric; Cleocin Phosphate; Cleocin T; Cleocin; Cleocin Vaginal Ovule; Clindagel; ClindaMax; ClindaReach; Clindesse; Evoclin Aerosol, topical [foam] Granules for oral solution Lotion Capsule Infusion, as phosphate [premixed in D5W] Solution, topical Cream, vaginal Injection, solution Suppository, vaginal Gel, topical Antibiotic, Lincosamide; Topical Skin Product, Acne Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug conc., infection site, and organism Treatment of susceptible bacterial infections, mainly those caused by anaerobes, streptococci, pneumococci, and staphylococci; bacterial vaginosis (vaginal cream, vaginal suppository); pelvic inflammatory disease (I.V.); topically in treatment of severe acne; vaginally for Gardnerella vaginalis Drug of Choice for Disease Drug of Choice for Organism(s) Acne Vulgaris Pelvic Inflammatory Actinomyces Species Disease Amnionitis Babesia microti Pneumonia, Brain Abscess Bacillus anthracis Aspiration, Endometritis Bacteroides and Prevotella Species Community-Acquired Furunculosis Campylobacter jejuni Pneumonia, Impetigo Clostridium perfringens Community-Acquired Joint Replacement, Late Gardnerella vaginalis Pyomyositis Infection Mycoplasma hominis and Mycoplasma Sinusitis, Community Lung Abscess genitalium Acquired, Chronic Mastitis Peptostreptococcus and Other Anaerobic Skin and Soft Tissue Gram-Positive Cocci Necrotizing Fasciitis Toxic Shock Syndrome Rhodococcus Species Osteomyelitis, Diabetic Vaginosis, Bacterial Foot Staphylococcus aureus, Methicillin-Susceptible Wound Infection, Osteomyelitis, Healthy Staphylococcus epidermidis, MethicillinSurgical Adult Susceptible Osteomyelitis, Pediatric Toxoplasma gondii Hypersensitivity to clindamycin, lincomycin, or any component of the formulation Topical and vaginal products: Additional contraindications: Previous pseudomembranous colitis, regional enteritis, ulcerative colitis [U.S. Boxed Warning]: Can cause severe and possibly fatal colitis. Renal Impairment: No adjustment required. Hepatic Impairment: Systemic use: Adjustment is recommended in patients with severe hepatic disease. B No. Enters breast milk/not recommended. Foam: Avoid fire, flame, or smoking during or following application. Clindagel: Do not store in direct sunlight. I.V.: Infusion solution in NS or D5W solution is stable for 16 days at room temperature, 32 days refrigerated, or 8 weeks frozen. After initial use, discard any unused portion of vial after 24 hours. Oral solution: Do not refrigerate reconstituted oral solution (it will thicken). Following reconstitution, oral solution is stable for 2 weeks. May be taken with food. Food: Peak concentrations may be delayed with food. Herb/Nutraceutical: St John's wort may decrease clindamycin levels. Erythromycin: Lincosamide Antibiotics may diminish the therapeutic effect of Erythromycin. Risk X Kaolin: May decrease the absorption of Lincosamide Antibiotics. Risk D Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D Skin: Dryness, burning, itching, scaliness, erythema, peeling of skin (lotion, solution); oiliness (gel, lotion) Vaginal: >10%: Genitourinary: Vaginal candidiasis (13%), vulvovaginal pruritus (from Candida albicans)

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Pharmacy Communications I
Doxycycline Trade Name Available Forms

Top 200 Drugs: List 5

Therapeutic Class MoA Indications

Contraindications Relative CIs Dose Adjustments Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions

ADRs > 10%

Adoxa; Alodox; Doryx; Doxy100; Monodox; Oracea; Oraxyl; Periostat; Vibra-Tabs; Vibramycin Capsule Syrup Injection, powder for reconstitution Tablet Powder for oral suspension Tablet, delayed-release coated pellets Antibiotic, Tetracycline Derivative Inhibits protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the cytoplasmic membrane Principally in the treatment of infections caused by susceptible Rickettsia, Chlamydia, and Mycoplasma; alternative to mefloquine for malaria prophylaxis; treatment for syphilis, uncomplicated Neisseria gonorrhoeae, Listeria, Actinomyces israelii, and Clostridium infections in penicillin-allergic patients; used for community-acquired pneumonia and other common infections due to susceptible organisms; anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure); treatment of infections caused by uncommon susceptible gram-negative and gram-positive organisms including Borrelia recurrentis, Ureaplasma urealyticum, Haemophilus ducreyi, Yersinia pestis, Francisella tularensis, Vibrio cholerae, Campylobacter fetus, Brucella spp, Bartonella bacilliformis, and Calymmatobacterium granulomatis, Q fever, Lyme disease; treatment of inflammatory lesions associated with rosacea; intestinal amebiasis; severe acne Drug of Choice for Disease Drug of Choice for Organism(s) Enterococcus Species Acne Rosacea Actinomyces Species Francisella tularensis Acne Vulgaris Bartonella Species Leptospira interrogans Amnionitis Borrelia burgdorferi Mycoplasma pneumoniae Bronchitis Brucella Species Rickettsia rickettsii Cervicitis Burkholderia mallei Staphylococcus aureus, Endometritis Calymmatobacterium Methicillin-Resistant granulomatis Epididymitis/Orchitis Stenotrophomonas Campylobacter jejuni maltophilia Impetigo Chlamydophila pneumoniae Treponema pallidum Pelvic Inflammatory Disease Chlamydophila psittaci Ureaplasma urealyticum Pneumonia, Community-Acquired Coxiella burnetii Vibrio cholera Prostatitis Ehrlichia Species Yersinia pestis Traveler's Diarrhea Urethritis, Nongonococcal Hypersensitivity to doxycycline, tetracycline or any component of the formulation Children 8 years of age, except in treatment of anthrax Photosensitivity may occur Renal Impairment: No adjustment necessary. Not dialyzable. D Enters breast milk/not recommended Capsule, tablet: Protect from light. I.V. infusion: Protect from light. Avoid Alcohol Food: Slightly decrease drug levels with food or milk. Administration with iron or calcium may decrease doxycycline absorption. May decrease absorption of calcium, iron, magnesium, zinc, and amino acids. Use sun protection Risk X: Retinoic Acid Derivatives Risk D: Antacids Bismuth Subsalicylate Penicillins Barbiturates CarBAMazepine Phenytoin Bile Acid Sequestrants Iron Salts Quinapril Bismuth Magnesium Salts Sucralfate Typhoid Vaccine % Not reported.

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Pharmacy Communications I
Fluconazole Trade Name Available Forms Therapeutic Class MoA Indications

Top 200 Drugs: List 5

Contraindications Dose Adjustments

Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions

Diflucan Infusion [premixed in sodium chloride or dextrose], Powder for oral suspension, Tablet Antifungal Agent, Oral; Antifungal Agent, Parenteral Interferes with fungal cytochrome P450 activity (lanosterol 14--demethylase), decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting cell membrane formation Treatment of candidiasis (vaginal, oropharyngeal, esophageal, urinary tract infections, peritonitis, pneumonia, and systemic infections); cryptococcal meningitis; antifungal prophylaxis in allogeneic bone marrow transplant recipients Drug of Choice or Alternative for Disease Drug of Choice or Alternative for Organism(s) Balanitis Blastomyces dermatitidis Endocarditis, Prosthetic Valve, Early Candida Species Endocarditis, Prosthetic Valve, Late Coccidioides immitis Esophagitis Cryptococcus neoformans Peritonitis, CAPD-Associated Histoplasma capsulatum Thrombophlebitis, Suppurative Malassezia furfur Prototheca Species Dematiaceous Fungi Dermatophytes Hypersensitivity to fluconazole, other azoles, or any component of the formulation; concomitant administration with cisapride Renal Impairment o No adjustment for vaginal candidiasis single-dose therapy o For multiple dosing, administer usual load then adjust daily doses as follows Hepatic impairment: Serious (and rarely fatal) hepatic toxicity (eg, hepatitis, cholestasis, fulminant failure) has been observed with azole therapy. Use with caution in patients with pre-existing hepatic impairment; monitor liver function closely and dosage adjustment may be warranted; discontinue if symptoms consistent with liver disease develop. C YES. Enters breast/not recommended (AAP rates compatible) PO suspension: Following reconstitution, discard unused portion after 2 weeks. Do not freeze. Injection: Do not freeze. Do not unwrap unit until ready for use. . Take full course of medication as ordered. Take with or without food. Follow good hygiene measures to prevent reinfection. Frequent blood tests may be required. Maintain adequate hydration unless instructed to restrict fluid intake. Report skin rash, redness, or irritation; persistent GI upset; urinary pattern changes; excessively dry eyes or mouth; or changes in color of stool or urine. Risk X: Risk D: Artemether Alfentanil Didanosine Protease Inhibitors Cisapride Alfentanil Docetaxel Rifamycin Derivatives Clopidogrel Benzodiazepines Eletriptan Saccharomyces Conivaptan boulardii BusPIRone Eplerenone Dofetilide Sirolimus Calcium Channel FentaNYL Dronedarone Blockers Solifenacin Gadobutrol Everolimus Except: Clevidipine. HMG-CoA Reductase Sunitinib Lumefantrine Cardiac Glycosides Tacrolimus Inhibitors Nilotinib Cilostazol Except: Fluvastatin; Temsirolimus Pimozide Pitavastatin; Rosuvastatin Colchicine Tolterodine QuiNIDine Irinotecan CycloSPORINE Vitamin K Antagonists QuiNINE Macrolide Antibiotics CYP2C19 (eg, warfarin) Ranolazine Except: Azithromycin Substrates Zolpidem Tetrabenazine Phenytoin CYP2C9 Substrates Thioridazine (High risk) Phosphodiesterase 5 Tolvaptan Inhibitors Ziprasidone % Not always reported. Central nervous system: Headache (2% to 13%), seizure, dizziness

ADRs > 10%

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Pharmacy Communications I
Fluticazone Trade Name Available Forms

Top 200 Drugs: List 5

Therapeutic Class MoA

Indications

Contraindications

Relative CIs Dose Adjustments Pregnancy Category Lactation Use Storage Instructions

Instructions for Use

Drug Interactions

Cutivate; Flonase; Flovent Diskus; Flovent HFA; Veramyst Aerosol for oral inhalation Cream Ointment Powder for oral inhalation Suspension, intranasal Corticosteroid, Inhalant (Oral); Corticosteroid, Nasal; Corticosteroid, Topical Fluticasone belongs to a group of corticosteroids which utilizes a fluorocarbothioate ester linkage at the 17 carbon position; extremely potent vasoconstrictive and anti-inflammatory activity; has a weak HPA inhibitory potency when applied topically, which gives the drug a high therapeutic index. The effectiveness of inhaled fluticasone is due to its direct local effect. The mechanism of action for all topical corticosteroids is believed to be a combination of three important properties: anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions Oral inhalation: Maintenance treatment of asthma as prophylactic therapy; also indicated for patients requiring oral corticosteroid therapy for asthma to assist in reduction of dose Intranasal: Management of seasonal and perennial allergic rhinitis and nonallergic rhinitis Topical: Inflammation and pruritus; atopic dermatitis Hypersensitivity; primary treatment of status asthmaticus or acute bronchospasm Topical: Do not use if infection is present at treatment site, in the presence of skin atrophy, or for the treatment of rosacea or perioral dermatitis Discontinuation of therapy: Withdraw systemic therapy with gradual tapering of dose. Hepatic Impairment: Fluticasone is primarily cleared in the liver. Use with caution; monitor. C Unknown, use caution Nasal spray: Do not refrigerate or freeze. Store in upright position with cap on. Oral inhalation: Flovent HFA: Discard device when the dose counter reads 000. Store with mouthpiece down. Flovent Diskus: Store dry place away from direct heat or sunlight. Discard after 6 weeks from removal from protective foil pouch or when the dose counter reads 0, device is not reusable. Although you may see improvement within a few hours of use, the full benefit of the medication may not be achieved for several days. Avoid exposure to chickenpox or measles. Report signs of infection or change in vision to prescriber. MDI: Sit when using. Take deep breaths for 3-5 minutes, and clear nasal passages before administration (use decongestant as needed). Hold breath for 5-10 seconds after use, and wait 1-3 minutes between inhalations. If also using inhaled bronchodilator, use before fluticasone. Rinse mouth and throat after use to reduce aftertaste and prevent candidiasis. Nasal spray: Shake gently. Use at regular intervals, no more frequently than directed. Report unusual cough or spasm; persistent nasal bleeding, burning, or irritation; or worsening of condition. Powder for oral inhalation: Flovent Diskus:Do not use with a spacer device. Do not exhale into the Diskus; use in a level horizontal position. Do not wash the mouthpiece. Topical: For external use only. Apply thin film to affected area only; rub in lightly. Wash hand thoroughly after use; avoid contact with eyes. Notify prescriber if skin condition persists or worsens. Do not use for treatment of diaper dermatitis or under diapers or plastic pants. Risk X: Natalizumab Vaccines (Live) Risk D: CYP3A4 Inhibitors (Strong) Echinacea Leflunomide Protease Inhibitors Central nervous system: Headache (2% to 14%) Respiratory: Throat irritation (3% to 22%), upper respiratory tract infection (14% to 21%)

ADRs > 10%

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Pharmacy Communications I
Ipratropium / Albuterol Trade Name Available Forms Therapeutic Class MoA

Top 200 Drugs: List 5

Indications Contraindications Relative CIs

Dose Adjustments Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions ADRs > 10%

Combivent; DuoNeb Aerosol for oral inhalation Solution for nebulization Anticholinergic Agent; Beta2 Agonist Ipratropium: Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation; local application to nasal mucosa inhibits serous and seromucous gland secretions. Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate Treatment of COPD in those patients who are currently on a regular bronchodilator who continue to have bronchospasms and require a second bronchodilator Hypersensitivity to ipratropium, albuterol, atropine (and its derivatives) or any component of the formulation Appropriate use: Do not exceed recommended dose; serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics. Patient education: A spacer device is recommended when using a metered-dose inhaler. Tolerance: Excessive use may result in tolerance. None C Unknown, use caution DuoNeb Protect from light. CombiventAvoid excessive humidity. Do not store near heat or open flame. Nebulization: Administer via jet nebulizer to an air compressor with an adequate air flow, equipped with a mouthpiece or face mask. MDI: Shake canister vigorously for 10 seconds. Prior to first use (or if not used for >24 hours) a test spray of 3 sprays is recommended. Avoid spraying into eyes. Some dosage forms may contain soya lecithin. Do not use in patients allergic to soya lecithin or related food products such as soybean and peanut. Respiratory: Bronchitis (2% to 12%), upper respiratory tract infection (11%) Ipratropium: Respiratory: Upper respiratory tract infection (9% to 34%), bronchitis (10% to 23%), sinusitis (1% to 11%)

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Pharmacy Communications I
Levalbuterol Trade Name Available Forms Therapeutic Class MoA Indications Contraindications Relative CIs

Top 200 Drugs: List 5

Dose Adjustments Pregnancy Category Lactation Use Storage Instructions

Instructions for Use

Drug Interactions

ADRs > 10%

Xopenex HFA Xopenex Aerosol, for oral inhalation, as tartrate Solution for nebulization Beta2 Agonist Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate Treatment or prevention of bronchospasm in children and adults with reversible obstructive airway disease Hypersensitivity to levalbuterol, albuterol, or any component of the formulation Appropriate use: Do not exceed recommended dose; serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics. Patient information: Seek medical attention in cases where acute symptoms are not relieved or a previous level of response is diminished. The need to increase frequency of use may indicate deterioration of asthma, and treatment must not be delayed. A spacer device or valved holding chamber is recommended when using a metered-dose inhaler. None C Unknown, use caution Aerosol: Protect from freezing and direct sunlight. Mouthpiece down. Discard after 200 actuations. Solution for nebulization: Store in protective foil pouch at room. Protect from light and excessive heat. Vials should be used within 2 weeks after opening protective pouch. Use within 1 week and protect from light if removed from pouch. Vials of concentrated solution should be used immediately after removing from protective pouch. Metered-dose inhaler: Shake well before use; prime with 4 test sprays prior to first use or if inhaler has not been use of more than 3 days. Clean actuator (mouthpiece) weekly. A spacer device or valved holding chamber is recommended when using a metered-dose inhaler. Solution for nebulization: Concentrated solution should be diluted prior to use. Blow-by administration is not recommended, use a mask device if patient unable to hold mouthpiece in mouth for administration. Alpha-/Beta-Blockers: May diminish the therapeutic effect of Beta2-Agonists. Risk D Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Risk DIobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X Endocrine & metabolic: Serum glucose increased, serum potassium decreased Neuromuscular & skeletal: Tremor (7%) Respiratory: Rhinitis (3% to 11%) Miscellaneous: Viral infection (7% to 12%)

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Minocycline Trade Name Available Forms

Top 200 Drugs: List 5

Therapeutic Class MoA Indications

Contraindications Relative CIs

Dose Adjustments Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions

ADRs > 10%

Dynacin; Minocin; Minocin PAC; Myrac; Solodyn Capsule Capsule, pellet filled Tablet Tablet, extended release: Antibiotic, Tetracycline Derivative Inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; cell wall synthesis is not affected Treatment of susceptible bacterial infections of both gram-negative and gram-positive organisms; treatment of anthrax (inhalational, cutaneous, and gastrointestinal); moderate-to-severe acne; meningococcal (asymptomatic) carrier state; Rickettsial diseases (including Rocky Mountain spotted fever, Q fever); nongonococcal urethritis, gonorrhea; acute intestinal amebiasis Extended release (Solodyn): Only indicated for treatment of inflammatory lesions of non-nodular moderate-to-severe acne Drug of Choice for Disease Drug of Choice for Organism(s) Acne Vulgaris Burkholderia cepacia Impetigo Burkholderia mallei Nocardia Species Stenotrophomonas maltophilia Hypersensitivity to minocycline, other tetracyclines, or any component of the formulation Photosensitivity Pediatrics: tooth discoloration (avoid in children 8 years of age) unless other drugs are not likely to be effective or are contraindicated. However, recommended in treatment of anthrax exposure. Renal Impairment: Use with caution; monitor BUN and creatinine clearance. Consider decreasing dose or increasing dosing interval (extended release). D No. Enters breast milk/not recommended Capsule (including pellet-filled), tablet: protect from heat. Protect from light and moisture. Extended release tablet: Protect from heat. Protect from light and moisture. With or without food. Do not chew, break, or dissolve extended release tablet. Complete full course of therapy; do not discontinue even if condition is resolved. May cause photosensitivity reaction (avoid sun, use sunscreen, or wear protective clothing). Report rash or itching, unresolved or persistent nausea or diarrhea, change in urinary output (excess). Risk X: Retinoic Acid Derivatives Risk D: Antacids Bile Acid Sequestrants Bismuth Bismuth Subsalicylate Iron Salts - Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose Magnesium Salts Penicillins Quinapril Sucralfate Typhoid Vaccine Zinc Salts % Not reported

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Pharmacy Communications I
Montelukast Trade Name Available Forms

Top 200 Drugs: List 5

Therapeutic Class MoA

Indications

Contraindications Relative CIs Dose Adjustments Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions ADRs > 10%

Singulair - No generic available Granules Tablet Tablet, chewable Leukotriene Receptor Antagonist Selective leukotriene receptor antagonist that inhibits the cysteinyl leukotriene receptor. Cysteinyl leukotrienes and leukotriene receptor occupation have been correlated with the pathophysiology of asthma, including airway edema, smooth muscle contraction, and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma. Cysteinyl leukotrienes are also released from the nasal mucosa following allergen exposure leading to symptoms associated with allergic rhinitis. Prophylaxis and chronic treatment of asthma; relief of symptoms of seasonal allergic rhinitis and perennial allergic rhinitis; prevention of exercise-induced bronchospasm Labeled for use in children >6 months! Hypersensitivity to montelukast or any component of the formulation Aspirin-sensitive asthmatics: Montelukast will not interrupt bronchoconstrictor response to aspirin or other NSAIDs. Patients with known aspirin sensitivity should continue to avoid these agents. No adjustment needed. (Not studied in patients with severe liver disease) B Unknown, use caution Protect from moisture and light. Granules: Store in original package; use within 15 minutes of opening packet. Do not stop other asthma medication unless advised by prescriber. Chewable tablet contains phenylalanine. Take every evening on a continuous basis; do not discontinue even if feeling better (this medication may help reduce incidence of acute attacks). Granules may be administered directly in the mouth or mixed with applesauce, carrots, rice, ice cream, baby formula, or breast milk (do not add to any other liquids); administer within 15 minutes of opening packet. You may experience mild headache (mild analgesic may help); or fatigue or dizziness (use caution when driving). Report skin rash or itching, abdominal pain or persistent GI upset, unusual cough or congestion, behavior and mood changes including suicide thoughts, feeling of numbness in arms or legs, flu-like illness, or worsening of asthmatic condition. CYP2C9 Inhibitors (Strong): May decrease the metabolism of CYP2C9 Substrates (High risk). Risk D None above 10%

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Nitrofurantoin Trade Name Available Forms Therapeutic Class MoA Indications

Top 200 Drugs: List 5

Contraindications

Dose Adjustments

Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions

Furadantin; Macrobid; Macrodantin Capsule Suspension, oral Misc. Antibiotic Inhibits several bacterial enzyme systems including acetyl coenzyme A interfering with metabolism and possibly cell wall synthesis Prevention and treatment of urinary tract infections caused by susceptible strains of E. coli, S. aureus, Enterococcus, Klebsiella, and Enterobacter Drug of Choice for Disease Drug of Choice for Organism(s) Asymptomatic Bacteriuria Staphylococcus saprophyticus Urinary Tract Infection, Uncomplicated Hypersensitivity to nitrofurantoin or any component of the formulation Significant renal impairment (anuria, oliguria, significantly elevated serum creatinine, or Clcr <60 mL/minute) Infants <1 month (due to the possibility of hemolytic anemia) Pregnancy at term (38-42 weeks gestation), during labor and delivery Cholestatic jaundice or hepatic impairment history with previous nitrofurantoin therapy Renal Impairment o Clcr <60 mL/minute: Contraindicated o Contraindicated in hemo- and peritoneal dialysis and continuous arteriovenous or venovenous hemofiltration. B (contraindicated at term) YES. Enters breast milk/not recommended (infants <1 month); AAP rates compatible Protect oral suspension from light. Because adverse effects have not been observed in animals, nitrofurantoin is classified pregnancy category B. Nitrofurantoin crosses the placenta, but very little reaches the amniotic fluid. Most published experiences with nitrofurantoin use during pregnancy have failed to identify any increased obstetric or teratogenic risks. Isolated reports of a potential increased risk for cardiovascular defects and a case report of upper limb paralysis have not been replicated in other studies. Use of nitrofurantoin during pregnancy has been generally well tolerated with rare reports of maternal toxicity including severe pulmonary reactions or hematologic adverse effects. Nitrofurantoin is contraindicated in pregnant patients at term (38-42 weeks gestation), during labor and delivery, or when the onset of labor is imminent due to the possibility of hemolytic anemia in the neonate. Ethanol: Avoid ethanol (may increase CNS depression). Food: Nitrofurantoin serum concentrations may be increased if taken with food. Risk X: Magnesium Trisilicate Norfloxacin Risk D: Typhoid Vaccine % Not reported

ADRs > 10%

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Penicillin VK Trade Name Available Forms

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Therapeutic Class MoA

Indications

Contraindications Dose Adjustments

Pregnancy Category Lactation Use Storage Instructions Instructions for Use

Drug Interactions

ADRs > 10%

NONE Note: 250 mg = 400,000 units Powder for oral solution Tablet Antibiotic, Penicillin Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Treatment of infections caused by susceptible organisms involving the respiratory tract, otitis media, sinusitis, skin, and urinary tract; prophylaxis in rheumatic fever Drug of Choice for Disease Drug of Choice for Organism(s) Erysipelas Actinomyces Species Pharyngitis Erysipelothrix rhusiopathiae Streptococcus pneumoniae, Drug-Susceptible Streptococcus pyogenes Hypersensitivity to penicillin or any component of the formulation Renal Impairment o Clcr 10-50 mL/minute: Administer every 8-12 hours. o Clcr <10 mL/minute: Administer every 12-16 hours. B YES. Enters breast milk/compatible Refrigerate suspension after reconstitution; discard after 14 days. Preferable on an empty stomach (1 hour before or 2 hours after a meal). Take a missed dose as soon as possible. If almost time for next dose, skip the missed dose and return to your regular schedule. Do not take a double dose. Maintain adequate hydration unless instructed to restrict fluid intake. Risk D: Fusidic Acid Tetracycline Derivatives Typhoid Vaccine: Gastrointestinal: Mild diarrhea, vomiting, nausea, oral candidiasis

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Pharmacy Communications I

Top 200 Drugs: List 5

Trimethoprim/Sulfamethoxazole Trade Name Bactrim; Bactrim DS; Septra; Septra DS; Sulfatrim Available Forms Injection, solution; Suspension, oral; Tablet; Note: The 5:1 ratio (SMX:TMP) remains constant in all forms. Therapeutic Class Antibiotic, Miscellaneous; Antibiotic, Sulfonamide Derivative 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 Indications Oral treatment of urinary tract infections due to E. coli, Klebsiella and Enterobacter sp, M. morganii, P. mirabilis and P. vulgaris; acute otitis media in children; acute exacerbations of chronic bronchitis in adults due to susceptible strains of H. influenzae or S. pneumoniae; treatment and prophylaxis of Pneumocystis jiroveci pneumonitis (PCP); traveler's diarrhea due to enterotoxigenic E. coli; treatment of enteritis caused by Shigella flexneri or Shigella sonnei I.V. treatment or severe or complicated infections when oral therapy is not feasible, for documented PCP, empiric treatment of PCP in immune compromised patients; treatment of documented or suspected shigellosis, typhoid fever, Nocardia asteroides infection Drug of Choice for Disease Drug of Choice for Organism(s) Listeria monocytogenes Acne Vulgaris Aeromonas Species Moraxella catarrhalis Asymptomatic Bacteriuria Bartonella Species Nocardia Species Brain Abscess Bordetella pertussis Pneumocystis jiroveci Bronchitis Brucella Species Providencia Species Furunculosis Burkholderia cepacia Salmonella Species Gastroenteritis, Bacterial Burkholderia mallei Shigella Species Impetigo Calymmatobacterium Staphylococcus aureus, granulomatis Meningitis, Community-Acquired, Methicillin-Resistant Adult Coxiella burnetii Staphylococcus epidermidis, Osteomyelitis, Diabetic Foot Cyclospora cayetanensis Methicillin-Resistant Otitis Media, Acute Escherichia coli Staphylococcus saprophyticus Prostatitis Haemophilus influenzae Stenotrophomonas maltophilia Sinusitis, Community-Acquired, Isospora belli Acute Toxoplasma gondii Traveler's Diarrhea Vibrio cholerae Urinary Tract Infection, Pyelonephritis Urinary Tract Infection, Uncomplicated Contraindications Hypersensitivity to any sulfa drug, trimethoprim, or any component of the formulation; megaloblastic anemia due to folate deficiency; infants <2 months of age; marked hepatic damage or severe renal disease (if patient not monitored); pregnancy (at term); breast-feeding Dose Adjustments Renal Impairment o Clcr 15-30 mL/minute: Administer 50% of recommended dose. o Clcr <15 mL/minute: Not recommended Pregnancy Category C Lactation Use NO. Enters breast milk/contraindicated (AAP rates compatible - usually) Storage Instructions Injection: Do not refrigerate. Less soluble in more alkaline pH. Protect from light. Solution must be diluted prior to administration. (Higher concentrations, expires faster. Range: 2-6 hr) Suspension, tablet: Protect from light. Instructions for Use Maintain adequate hydration unless instructed to restrict fluid intake. Report immediately any skin rash, redness, peeling, or irritation. Report persistent headache or dizziness, CNS changes. Drug Interactions Risk X: Dofetilide ; Procaine Risk D: CYP2C9 Inhibitors (Strong) Methotrexate Typhoid Vaccine Leucovorin-Levoleucovorin Procainamide Vitamin K Antagonists (eg, warfarin) Methotrexate ADRs > 10% % Not reported

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