Brand: Torsemide

Brand: Tramadol

Brand: Tramadol

Brand: Tramadol

Brand: Trazodone

Brand: Triamcinolone Topical

Brand: Triamcinolone Topical

Brand: Triamterene/Hydrochlorothiazide

Brand: Triamterene/Hydrochlorothiazide

Brand: Trimethoprim/Sulfamethoxazole

Brand: Trimethoprim/Sulfamethoxazole

Brand: Valacyclovir

Brand: Valsartan

Brand: Varenicline

Brand: Venlafaxine

Brand: Verapamil

Brand: Warfarin

Brand: Zolpidem

Brand: Zolpidem

Brand: Zolpidem

Brand: Torsemide

Brand: Tramadol

Brand: Trazodone

Brand: Triamcinolone Topical

Brand: Triamterene/Hydrochlorothiazide

Brand: Trimethoprim/Sulfamethoxazole

Brand: Valacyclovir

Brand: Valsartan

Brand: Varenicline

Brand: Venlafaxine

Brand: Verapamil

Brand: Warfarin

Brand: Zolpidem

Brand: Zolpidem

Indication: Edema related to heart failure, renal failure, hepatic cirrhosis: Adults, initial 10-20 mg po daily, may titrate to maintenance dose (max 200 mg/d)

Indication: Pain, chronic, moderate to moderately severe: Immediate release, 50 mg po q4-6h prn, may titrate to 400 mg/d; extended release, initial, 100 mg po daily, may titrate to 300 mg/d; to convert from immediate release, convert 1:1 and round down to nearest 100 mg dose

Indication: Major depressive disorder: Adults, 150 mg po daily in divided doses, may titrate to 400 mg/d;

Indication: Skin disorders: Apply thin layer topically to affected area daily or bid

Indication: Edema: 37.5 mg/25 mg, 1-2 tablets or capsules po daily; HTN: 37.5 mg/25 mg, 1 tablet or capsule po daily, may titrate to 75 mg/50 mg po daily

Indication: Acute infective exacerbation of COPD: 800 mg SMZ and 160 mg TMP po q12h × 3-7 d; HIV infection, Pneumocystis pneumonia: 1600 mg SMZ and 320 mg TMP po bid × 21 d; HIV infection, Pneumocystis pneumonia, prophylaxis: Adults, 800 mg SMZ and 160 mg TMP po daily; Children ≥1 mo of age, 750 mg/m2/d SMZ and 150 mg/m2/d TMP in 2 divided doses po 3 times/wk on consecutive days; Traveler’s diarrhea: 800 mg SMZ and 160 mg TMP po bid × 5 d; Urinary tract infection: Adult, 800 mg SMZ and 160 mg TMP po bid × 10-14 d; Children ≥2 mo of age, 8 mg/kg TMP component/d po bid × 10 d

Indication: Genital herpes simplex: Initial episode, 1 g po bid × 10 d; recurrent, 500 mg bid × 3 d; Genital herpes simplex: Suppressive therapy, immunocompetent, 1 g po daily; HIV infected, 500 mg po bid; Herpes zoster, shingles: 1 g po tid × 7 d; Varicella: Children ≥2 y of age, 20 mg/kg po tid × 5 d; Herpes labialis (cold sores): 2 g po bid × 1 d

Indication: Heart failure: 20-40 mg po bid, may titrate to 320 mg/d; HTN: 80-160 mg po daily, may titrate to 320 mg po daily; Acute coronary syndrome: 20 mg po bid, may titrate to 320 mg po daily

Indication: Smoking cessation: Adults and adolescent ≥17 yo: Initial dose, 0.5 mg po daily × 3 d, then 0.5 mg po bid × 4 d, then 1 mg po bid for the following 11 wk; may repeat additional 12 wk treatment if patient has not stopped smoking; patient should set a quit date and initiate varenicline 7 d prior

Indication: Generalized anxiety disorder: Extended release, 37.5-75 mg po daily, may titrate to 225 mg/d; Depression: Immediate release, 37.5-75 mg po daily in 2-3 divided doses, may titrate to 375 mg/d; extended release, 37.5-75 mg po daily, may titrate to 375 mg/d; Panic disorder: Extended release, 37.5 mg po daily × 7 d, then 75 mg po daily, then may titrate to 225 mg/d; Social anxiety disorder: Extended release, 37.5 mg po daily, may titrate to 75 mg po daily;

Indication: Angina: Immediate release, 80-120 mg po tid; extended release, 180 mg po daily hs, may titrate to 480 mg po daily; Atrial arrhythmia or paroxysmal supraventricular tachycardia prophylaxis: Immediate release, 240-320 mg/d in 3-4 divided doses, may titrate to 480 mg/d in nondigitalized patients; HTN: Immediate release, 80 mg po tid, may titrate to 360-480 mg/d; extended release, 180-200 mg po daily hs, may titrate to 400-480 mg po daily; extended release, 180 mg po daily in AM, may titrate to 240-480 mg/d

Indication: Anticoagulation, for multiple FDA-labeled indications, all dosed similarly, including atrial fibrillation; myocardial infarction; prosthetic cardiac valve component embolism; pulmonary embolism; thrombosis, post-myocardial infarction; venous thromboembolism: Initial, 2-5 mg po daily, adjust dose based on INR; usual maintenance 2-10 mg po daily

Indication: Insomnia, short-term treatment: Immediate release, spray or sublingual, 1.75-5 mg (females), 3.5-10 mg (males) po daily immediately before bedtime; extended release, 6.25 mg (females), 6.25-12.5 mg (males) po daily immediately before bedtime

MOA: _______ is a loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle’s loop, where it decreases sodium reabsorption by competing for the chloride site on the Na+-K+-2Cl- cotransporter.

MOA: _____ is a mu agonist and a weak inhibitor of serotonin and norepinephrine reuptake. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brainstem respiratory centers’ response to carbon dioxide tension and electrical stimulation.

MOA: The mechanism of antidepressant action is not fully understood but suspected to be related to its potentiation of serotonergic activity in the CNS by inhibiting reuptake of serotonin. _____ also significantly blocks histamine (H1) and α1-adrenergic receptors.

MOA: _____ has anti-inflammatory, antipruritic, and vasoconstrictive properties. Corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid.

MOA: _____ acts directly from the distal tubular lumen on active sodium exchange for potassium and hydrogen, producing a mild diuresis that is independent of aldosterone concentration. Antihypertensive activity is inconsistent and less pronounced than with _____ or _____ . ______ is a ______ diuretic that increases sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron; a mild diuresis of slightly concentrated urine results.

MOA: _____ competitively inhibits the synthesis of dihydropteroic acid (an inactive folic acid precursor) in microorganisms. ______ inhibits the enzymatic reduction of dihydrofolic acid to tetrahydrofolic acid. The combination is active against many bacteria and P. carinii. TMP/SMZ has in vitro activity against MRSA, but clinical success has been variable and unpredictable.

MOA: ______ is a prodrug of ___. ___ is an acyclic nucleoside analogue of deoxyguanosine that is selectively phosphorylated by the virus-encoded thymidine kinase to its monophosphate form. Cellular enzymes then convert the monophosphate to the active antiviral ___ triphosphate, which inhibits viral DNA synthesis by incorporation into viral DNA, resulting in chain termination. ______ has potent activity against herpes simplex virus (HSV) 1 and 2 and varicella-zoster virus (VZV).

MOA: ______ is a selective, reversible, competitive antagonist of the angiotensin II receptor, which is responsible for the physiologic effects of angiotensin II, including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.

MOA: _____ binds with high affinity and selectivity at α4β2 neuronal nicotinic acetylcholine receptors. Its efficacy in smoking cessation is believed to be the result of activity at α4β2 subtype of the nicotinic receptor where its binding produces agonist activity, while simultaneously preventing nicotine binding to these receptors.

MOA: Potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, α-adrenergic, or histamine receptors.

MOA: Inhibits calcium “slow channels” on vascular smooth muscle and myocardium producing relaxation of muscle and vasodilation. Increases myocardial oxygen delivery and slow conduction through the AV node.

MOA: _____ prevents the conversion of vitamin K back to its active form from vitamin K epoxide. This impairs formation of the vitamin K–dependent clotting factors II, VII, IX, and X (prothrombin) and proteins C and S (physiologic anticoagulants).

MOA: _____ binds the benzodiazepine receptor but is structurally different from a benzodiazepine. Sedative and hypnotic effects are due to increased chloride conductance, neuronal hyperpolarization, inhibition of action potential, and decrease in neuronal excitability.

BBW: Torsemide

BBW: Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestions, CYP2D6 in children, neonatal withdrawal syndrome, drug interactions, concurrent benzodiazepines, medication errors, drug interactions with P450s

BBW: Suicidial ideation, not for use in children

BBW: Hyperkalemia

BBW: Pregnancy

BBW: Suicidal ideation, not approved in children

BBW: Bleeding

BBW: Risk of complex sleep behaviors (sleepwalking, sleep driving, etc)

Common: None known

Common: Constipation, GI distress, dizziness, sedation, edema, sweating, pruritus, headaches, flushing

Common: Dizziness, sedation, headache, nausea, somnolence, xerostomia

Common: None Known

Common: Hypotension, dizziness, headache

Common: Diarrhea, nausea

Common: Malaise, headache, nausea, neutropenia, nasopharyngitis, increased LFTs

Common: Dizziness, increased BUN

Common: Dream disorder, nausea, headache, insomnia, irritability

Common: Dizziness, headache, insomnia, nausea, somnolence, xerostomia, weakness

Common: Gingival hyperplasia

Common: Bleeding

Common: Dizziness, drowsiness, headache

Less Common: Polyuria, ECG abnormality, GI distress, myalgia

Less Common: Dyspnea, xerostomia, depression, orthostatic hypotension

Less Common: Backache, blurred vision, constipation, diarrhea, fatigue, feeling nervous, headache, hypotension, insomnia, syncope, tremor, vomiting

Less Common: Dry skin, burning sensation, stinging, pruritus/atrophy at site of administration

Less Common: Altered sense of taste, cramps, constipation, diarrhea, dry mouth, hyperglycemia, hyperuricemia, hypokalemia, hypomagnesemia, hyponatremia, impotence, loss of appetite, nausea, orthohypotension, photosensitivity, rash, tachycardia, urticaria, vomiting

Less Common: Skin rash, urticaria

Less Common: Vomiting, diarrhea, dizziness, abdominal pain, rash

Less Common: Back pain, cough, diarrhea, drowsiness, headache, hyperkalemia, hypotension, nausea, nephrotoxicity, rash, tachycardia

Less Common: Constipation, flatulence, vomiting, depression, anxiety

Less Common: Anxiety, asthenia, bleeding, blurred vision, diaphoresis, HTN, hyponatremia, hypercholesterolemia, sexual dysfunction, tremor, vomiting, weight loss, sexual dysfunction, sweating

Less Common: Bradyarrhythmia, constipation, dizziness, fatigue, headache, hypotension, indigestion, nausea, palpitations, peripheral edema, rash, syncope, elevated liver enzymes

Less Common: Anemia, epistaxis, rash

Less Common: Chest pain, blurred vision, nausea, diarrhea, confusion, impaired motor coordination, somnolence

Rare: Angioedema, thrombocytopenia, electrolyte abnormalities, anuria

Rare: Cardiac arrest, physical dependence, tolerance, seizures, pancreatitis, suicidal ideation, anemia, serotonin syndrome, adrenal insufficiency, decreased sex hormones

Rare: Bleeding risk, cardiac dysrhythmia, fractures, priapism, prolonged QTc, serotonin syndrome, suicidal thoughts, torsade de pointes

Rare: HPA suppression has been reported when used with occlusive dressings over larger surface areas

Rare: Cardiac arrhythmias, hepatitis, hyperkalemia, gout, pancreatitis, Stevens-Johnson syndrome, decreased visual acuity

Rare: Severe hypersensitivity, renal failure, hepatic failure, pancytopenia, arrhythmias, Stevens-Johnson syndrome, hyperkalemia, hypoglycemia, hemolytic anemia

Rare: Severe hypersensitivity, renal failure, TTP

Rare: Angioedema, rhabdomyolysis

Rare: Abnormal behavior, suicidal thoughts, angioedema, hypersensitivity reactions, increased risk of accidents, increased risk of cardiovascular related events, sleepwalking, seizures

Rare: GI hemorrhage, hepatotoxicity, serotonin syndrome, suicidal thoughts

Rare: Congestive heart failure, heart block, hepatotoxicity, pulmonary edema

Rare: hemorrhage (particularly GI tract), purple toe syndrome, tissue necrosis, calciphylaxis

Rare: Tachycardia, complex behavior, abnormal thinking, behavior changes, anaphylaxis, worsening of depression, angioedema, drug dependence, slowed or difficult breathing when used in combination with opioids, falls leading to severe injuries associated with decreased level of consciousness

Counseling: Avoid alcohol and NSAIDs. Increased risk of sun-sensitivity; use sunscreen and avoid tanning. Report signs/symptoms of hypotension or decreased urine output; severe skin reactions. Eat high-potassium foods, as directed by HCP. Monitor weights daily.

Counseling: Use a laxative for preventing constipation if used chronically. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants. Extended-release products must not be crushed or chewed but may be taken with or without food, and always the same way to avoid variability in absorption.

Counseling: Avoid driving and other activities requiring mental alertness or coordination until drug effects are realized, as this medicine may cause dizziness or somnolence. Report signs/symptoms of priapism immediately. Avoid use of MAOI within the past 14 d. Avoid sudden discontinuation of drug. Do not drink alcohol, or use barbiturates or other CNS depressants while taking this drug.

Counseling: Apply thin layer to affected area of skin. Skin should be clean and intact at site of application. Wash hands before and after application. Avoid contact with eyes and do not ingest by mouth. Avoid occlusive dressings or tight-fitting clothes over site of administration.

Counseling: May cause dizziness. Rise slowly from a sitting or lying position to avoid dizziness. Avoid foods that are high in potassium, potassium supplements, or potassium-containing salt substitutes. Avoid alcohol and NSAIDs. May cause photosensitivity; use sunscreen. Use with caution in patients with sulfonamide allergy.

Counseling: Complete full course of therapy. For the suspension, shake well and store at room temperature and protect from light. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner. May cause photosensitivity; use sunscreen. Maintain adequate hydration during therapy to prevent kidney complications. Seek medical attention for severe diarrhea, dark urine, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath.

Counseling: Seek medical attention if decreased urination, unusual bruising or bleeding, blistering skin rash, or shortness of breath. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP. If using for prophylaxis, this medication should reduce the number of breakouts. Maintain adequate hydration during therapy to prevent renal complications.

Counseling: Do not discontinue abruptly. Use potassium supplements or salt substitutes only under medical supervision. This medicine may cause dizziness. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Recommend avoiding alcohol and NSAIDs while taking this drug.

Counseling: Take drug after eating and with a full glass (240 mL) of water. If you experience sleepwalking, seizures signs of hypersensitivity (shortness of breath), mental status changes or suicidal ideation, stop taking and contact HCP. May be used with other nicotine replacement products to help alleviate withdrawal from nicotine. Limit alcohol use.

Counseling: Take _____ with food, but avoid alcohol. Extended-release capsules and tablets should be swallowed whole. Contents of extended-release capsules may be sprinkled on food and swallowed without chewing, followed by water. Symptomatic improvement may not be evident for a few weeks. Do not discontinue drug abruptly, as this may precipitate withdrawal symptoms such as dysphoric mood, irritability, and agitation. Avoid activities requiring mental alertness; may cause dizziness or somnolence.

Counseling: Do not crush or chew extended-release products. Contents of extended-release capsules may be sprinkled on food and swallowed without chewing, followed by water. Report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope. Avoid sudden discontinuation of drug, as this may precipitate hypertensive rebound/crisis. Rise slowly from a sitting or lying position to avoid dizziness. Avoid alcohol and grapefruit juice. Calcium channel blockers are not drugs of first choice for hypertension, but may be used in combination with other agents in patients with inadequate blood pressure response.

Counseling: Report signs/symptoms of hemorrhage, skin and tissue necrosis. Avoid situations/activities in which cuts, bruising, or injury is likely to occur. Many significant drug-drug interactions; consult health-care professional prior to new prescription or OTC use. Avoid alcohol, cranberry products, and drastic changes in vitamin K consumption from diet (cruciferous vegetables).

Counseling: Take on an empty stomach. May cause daytime drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Take immediately prior to bedtime. Warn patient of the risk of “sleep-driving” and other complex behaviors (eg, preparing and eating food, making phone calls) when the patient is not fully awake. Risk is increased when drug is combined with alcohol or other CNS depressants. Bed partner should monitor for irregular respiration.

Pearls: ____ is drug of first choice for volume overload related to heart failure; however, it has somewhat erratic absorption. If inadequate response to furosemide, a trial of ____ is warranted as it has both better absorption and a longer half-life than furosemide. Loop diuretics are rarely used for management of HTN. A dose of 10-20 mg of ____ is equivalent to approximately 40 mg of _____.

Pearls: Tolerance and physical dependence may occur with chronic use; avoid abrupt discontinuation. ___-related deaths have been reported in patients with histories of emotional disturbances, suicidal ideation/attempts, or misuse of tranquilizers, alcohol, and other CNS-active drugs. Suspension and creams are available in compounding kits. Avoid concomitant use with benzodiazepines. Although ___ is an opiate receptor agonist, it does not appear to produce significant respiratory depression or cardiovascular effects in most patients. The FDA is requiring updates to opioid labeling, including updated boxed warnings, indications, dosing, and medication guide, as well as a new warning for opioid hyper-algesia.

Pearls: Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior.

Pearls: Large number of dosage formulations (foams, gels, shampoos, etc), both by prescription and OTC, are available. Oral and inhaled formulations, administered for systemic action, also available and used for similar indications as other oral corticosteroids. Application to large surface areas, prolonged use, and occlusive dressings increase risk of systemic absorption and toxicity; pediatric patients are more susceptible to systemic absorption. TAC is an error-prone abbreviation; avoid.

Pearls: Safety and effectiveness not established in children.

Pearls: Avoid use in patients with G6PD deficiency (increased risk of hemolytic anemia). Preferred agent for Pneumocystis pneumonia prevention in HIV-infected patients when CD4 count is <200.

Pearls: Not indicated for children <2 y of age. Use caution with concurrent nephrotoxins. Drug of choice for herpes zoster infection. Improved oral bioavailability over ___, allowing twice-daily dosing of ___(compared to 5 times/d dosing of ___).

Pearls: ARBs can cause injury or death to the developing fetus when used during 2nd and 3rd trimesters. Therapy should be stopped as soon as possible when pregnancy is detected. In hypertensive patients with chronic kidney disease, either an ACEI or ARB is recommended as first-line therapy to improve kidney outcomes. While ACEIs are recommended as first-line therapy, in patients with heart failure or with ST-elevation AMIs, ARBs are recommended for patients unable to tolerate ACEIs. Oral solution and tablet formulations are not therapeutically equivalent. A higher dose may be required when converting from oral solution to tablet form, titrate based on response.

Pearls: A large, randomized, double-blind, placebo-controlled study assessing the effect of varenicline on psychiatric illness showed no difference between varenicline and placebo in exacerbation or new onset of psychiatric illness between the groups, which resulted in the removal of a previous box warning for serious neuropsychiatric events. In a recent meta-analysis, there was an increased, but not statistically significant, incidence of major adverse cardiovascular events (a combined outcome of cardiovascular-related death, nonfatal AMI, and nonfatal stroke) in patients using ___ when compared to placebo. Initiating therapy up to 35 d prior to quit date and extending therapy to 24 wk have been shown to improve quit rate and long-term abstinence rates. ____is not effective in improving abstinence from smoking in children 12-16 y of age and should not be used.

Pearls: May convert to extended-release capsules or tablets based on nearest equivalent dose (mg/d) of stable immediate-release dose. Patients should not be initiated or titrated on 112.5 mg extended-release tablet; patients on ≥75 mg on another ___ ER product may be switched. At low doses (37.5 mg/d), ___functions as an SSRI; at doses >225 mg/d, it affects serotonin and norepinephrine. When discontinuing, gradually taper over at least 2-4 wk to minimize withdrawal symptoms.

Pearls: Not approved in children <18 y of age.

Pearls: Patients often managed in pharmacist-run anticoagulation clinics. Consult local protocols. Excessive anticoagulation with warfarin can be corrected with vitamin K. Pharmacogenetic testing for initial dosing of warfarin decreases the time required to achieve a therapeutic INR, but improved clinical efficacy and decreased adverse effects have not been demonstrated, and coordinating testing, results reporting, and initiation of therapy are pragmatically challenging; therefore, pharmacogenetic testing is not routine. Many alternatives are available to ___; in general, may discontinue ___and initiate another anticoagulant when the INR ≤2. When switching from an alternative to ___, generally reduce the alternative anticoagulant dose by 50%, initiate warfarin, and discontinue the alternative agent when INR ≤2.

Pearls: Not for long-term use (usually 7-10 d only). Long-term use may result in dependence, abuse, or tolerance. Use caution in elderly, appear more sensitive to the effects; dose reductions of 50% have been recommended. Use of CNS depressants with caution, may have additive effects. Recommended dose for immediate-release products was recently lowered from 10 to 5 mg and from 12.5 to 6.25 mg for extended-release products in women to reduce risk of morning somnolence. Dispense with medication safety guide. Should avoid concomitant use with opioids. New boxed warning for benzodiazepines expected in 2021, warning about misuse, addiction and withdrawal reactions.