Brand: Sumatriptan

Brand: Sumatriptan

Brand: Sumatriptan

Brand: Sumatriptan

Brand: Tadalafil

Brand: Tadalafil

Brand: Tamoxifen

Brand: Tamoxifen

Brand: Tamsulosin

Brand: Terazosin

Brand: Testosterone

Brand: Testosterone

Brand: Timolol

Brand: Timolol

Brand: Tiotropium

Brand: Tiotropium

Brand: Tizanidine

Brand: Tolterodine

Brand: Topiramate

Class: Antimigraine Serotonin Receptor Agonist

Class: Erectile Dysfunction Agent; Pulmonary HTN Agent

Class: Antineoplastic Agent, Estrogen Receptor Antagonist

Class: α1-Adrenergic Blocker

Class: Androgen. C-III

Class: Beta-blocker, Antiglaucoma Agent

Class: Anticholinergic Bronchodilator

Class: Centrally Acting Skeletal Muscle Relaxant, α2-Agonist

Class: Antimuscarinic

Class: Anticonvulsant

Dosage: Oral Tablet: 25 mg, 50 mg, 100 mg; Nasal Solution: 5 mg/actuation, 10 mg/actuation, 20 mg/actuation; Exhaler Powder, Nasal: 11 mg per nosepiece; Solution, for Subcutaneous Injection: 3 mg/0.5 mL, 4 mg/0.5 mL, 6 mg/0.5 mL

Dosage: Oral Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg; Oral Suspension: 20 mg/5 mL

Dosage: Tablet, Oral: 10 mg, 20 mg; Solution, Oral: 10 mg/5 mL

Dosage: Oral Capsule: 0.4 mg

Dosage: Oral Capsule: 1 mg, 2 mg, 5 mg, 10 mg

Dosage: Topical Gel: 1%, 1.62%, 2%; Topical Solution: 30 mg/actuation; Transdermal Cream: 2%; Transdermal Gel: 25 mg/2.5 g, 20.25 mg/1.25 g, 40.5 mg/2.5 g, 50 mg/5 g; Gel, Transdermal Pump: 10 mg/actuation, 12.5 mg/actuation, 20.25 mg/actuation; Transdermal Patch: 2 mg/24 h, 4 mg/24 h; Nasal Gel: 5.5 mg/actuation; Oral Capsule: 100 mg, 112.5 mg, 150 mg, 158 mg, 198 mg, 200 mg, 237 mg

Dosage: Ophthalmic Solution: 0.25%, 0.5%; Ophthalmic Gel: 0.25%, 0.5%

Dosage: Inhalation Capsule (HandiHaler): 18 mcg; Aerosol Solution (Respimat): 1.25 mcg/actuation, 2.5 mcg/actuation

Dosage: Oral Capsule: 2 mg, 4 mg, 6 mg; Oral Tablet: 2 mg, 4 mg

Dosage: Oral Tablet: 1 mg, 2 mg; Oral Capsule, Extended Release: 2 mg, 4 mg

Dosage: Oral Capsule, Sprinkle: 15 mg, 25 mg; Oral Tablet: 25 mg, 50 mg, 100 mg, 200 mg; Oral Capsule, Extended Release, 24 h: 25 mg, 50 mg, 100 mg; Oral Capsule, Extended Release, 24 h Sprinkle: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg

Indication: Migraine: Adults, oral, 25-100 mg po at onset of migraine, may repeat after 2 h prn; max 200 mg/d; Nasal, 5-20 mg in 1 nostril, may repeat after 2 h; max 40 mg/d; SUBQ, 6 mg SUBQ; max 12 mg/d; Children, 5-12 yo, nasal, 5-20 mg in 1 nostril; SUBQ, 3-6 mg SUBQ; Cluster headaches: 6 mg SUBQ once; max 12 mg/d, Nasal, 20 mg in 1 nostril, may repeat after 2 h; max 40 mg/d; SUBQ, 6 mg SUBQ; max 12 mg/d

Indication: Erectile dysfunction: Daily use, ___ only, 2.5-5 mg po daily; prn use, 10-20 mg po 30 min prior to anticipated sexual activity, max frequency is once daily. May also use 2.5-5 mg po daily without regard to timing of sexual activity; Benign prostatic hyperplasia: ___ only, 5 mg po daily; when combined with finasteride, ___ administration should be discontinued at or before 26 wk; Pulmonary HTN: ___ only, 40 mg po daily

Indication: Breast cancer, risk reduction, pre- and postmenopausal women at high risk: Adults, 20 mg po daily × 5 y; Breast cancer, treatment: Adults, 20 mg po daily × 5-10 y in adjuvant setting, or until disease progression in the metastatic setting

Indication: Benign prostatic hyperplasia: 0.4 mg po daily, may titrate to 0.8 mg po daily

Indication: Benign prostatic hyperplasia: 1 mg po daily hs, may titrate to 20 mg/d; HTN: 1 mg po daily hs, may titrate to 20-40 mg/d

Indication: Hypogonadism (men): 5 g gel (50 mg active drug) daily to clean, dry, intact skin, may titrate dose to 7.5-10 g daily; one 5-mg patch daily × 24 h, may titrate to 7.5 mg/d, 120-200 mg po bid

Indication: Glaucoma: Adults and Children, 1 drop in affected eye(s) daily-bid

Indication: COPD: Inhale contents of 1 capsule (18 mcg) daily using manufacturer-provided device (do not swallow capsules) or 2 actuations of the aerosol solution once daily; Asthma (___ only): Adults and Children ≥12 y of age, 2 actuations of the aerosol solution once daily

Indication: Muscle Spasticity: 2 mg po up to tid, may titrate to 8 mg po q6-8h with max dose of 36 mg/d

Indication: Bladder muscle dysfunction, overactive: Immediate release, 1-2 mg po bid; Extended release, 2-4 mg po daily; may titrate dose to tolerability and response

Indication: Focal (partial) or generalized tonic-clonic seizure, monotherapy or adjunct: Children 2-16 y of age, 1-3 mg/kg/d (max 25 mg) po daily × 1 wk, may titrate to 5-9 mg/kg/d; Children ≥17 y of age and Adults, 25 mg po bid × 1 wk, may titrate to max of 200 mg po bid; Migraine prevention: Immediate release only, initial 25 mg po daily × 1 wk, may titrate to max of 50 mg po bid

MOA: ___ binds with high affinity to serotonin (5-HT) subtypes 1B, 1D, and 1F receptors. It has no significant affinity or pharmacologic activity at adrenergic α1, α2, or β; dopaminergic D1 or D2; muscarinic; or opioid receptors. Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1 receptors located on intracranial blood vessels) or through activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.

MOA:Inhibition of phosphodiesterase type 5 ___ by ___ enhances erectile function by increasing the amount of cyclic GMP enhancing erectile function and pulmonary vasculature relaxation. Penile erection during sexual stimulation is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic GMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum and vasodilation in the pulmonary bed.

MOA: ___ is a selective estrogen receptor modulator (SERM) that competitively binds to estrogen receptors on tumors, inhibiting tumor growth.

MOA: ___ is closely related to quinazoline derivatives that selectively block postsynaptic α1-adrenergic receptors. Total peripheral resistance is reduced through arterial and venous dilations. Reflex tachycardia that occurs with other vasodilators is infrequent because there is no presynaptic α2-receptor blockade. The drugs also decrease total cholesterol, increase HDL-cholesterol, and may improve glucose tolerance and reduce left ventricular mass during long-term therapy. They increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate.

MOA: ___ selectively blocks postsynaptic α1-adrenergic receptors. Total peripheral resistance is reduced through arterial and venous dilations. Reflex tachycardia that occurs with other vasodilators is infrequent because there is no presynaptic α2-receptor blockade. Increases urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate.

MOA: ___ is an endogenous androgen. Androgens are responsible for normal growth and development of male sex organs. ___ is involved in the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution; laryngeal enlargement; vocal cord thickening; alterations in body musculature; and fat distribution.

MOA:Blocks both beta1- and beta2-adrenergic receptors and reduces intraocular pressure by reducing aqueous humor production.

MOA: ___ is a long-acting antimuscarinic agent, which is often referred to as an anticholinergic. It has similar affinity to the subtypes of muscarinic receptors, M1-M5. In the airways, it exhibits pharmacologic effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation. The bronchodilation following inhalation of tiotropium is predominantly a site-specific effect.

MOA: ___ is a centrally acting muscle relaxant. The drug is an imidazole derivative, structurally unrelated to other muscle relaxants. ___ is an agonist of α2-adrenergic receptors, which decreases spasticity by increasing presynaptic inhibition; however, it does not have antihypertensive properties.

MOA: ___, a competitive muscarinic receptor antagonist, has a high binding affinity for the cholinergic muscarinic receptors that mediate contraction of the urinary bladder and salivation. The drug exerts its significant effects on the lower urinary tract by increasing the residual urine and decreasing detrusor pressure.

MOA:The exact mechanisms by which ___ exerts its anticonvulsant and migraine prophylaxis effects are unknown. Electrophysiologic and biochemical evidence suggests that topiramate blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-A receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV.

BBW: Uterine malignancies, stroke, PE

BBW: Secondary exposure (topical), BP increases (oral); pulmonary oil microembolism (injectable)

Common: None known

Common: Flushing, nausea, myalgia, headache

Common: Flushing, HTN, edema, hot flashes, vaginal discharge

Common: Dizziness, headache, abnormal ejaculation, rhinitis

Common: Asthenia, dizziness

Common: Benign prostatic hyperplasia, testicular atrophy, PSA increase

Common: Blurry vision, stinging

Common: Xerostomia, upper respiratory infection

Common: Hypotension, xerostomia, asthenia, dizziness, somnolence, muscle weakness

Common: Xerostomia

Common: Ataxia, loss of appetite, dizziness, impaired psychomotor performance, somnolence, fatigue, nystagmus, low serum bicarbonate

Less Common:Nausea, asthenia, dizziness, somnolence

Less Common:Nasopharyngitis, angina, chest pain, hypotension

Less Common:Venous thrombosis, insomnia, thrombocytopenia, elevated liver function tests, fractures, osteoporosis, hyperlipidemia

Less Common:Asthenia, edema, fatigue, hypotension, nausea, somnolence, vertigo

Less Common:Dyspnea, headache, impotence, nausea, nasal congestion, orthostatic hypotension, palpitations, peripheral edema, priapism, somnolence, syncope

Less Common:Acne, headache, gynecomastia, alopecia, impotence, aggressive behavior, HTN

Less Common:Bradycardia, hypotension, dizziness, drowsiness, urticarial, xerostomia

Less Common:Constipation, pharyngitis, sinusitis, headache, dysphonia, application site irritation

Less Common:Constipation, vomiting, dyskinesia, amblyopia, feeling nervous, syncope, depression

Less Common:Constipation, dizziness, headache, increased HR, indigestion, somnolence, vertigo, chest pain

Less Common:Disorder of language, diplopia, weight loss, depression, nausea, nephrolithiasis, flushing

Rare: Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, AMI, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis

Rare: Stevens-Johnson syndrome, AMI, seizures, strokes, sudden hearing loss

Rare: Thrombosis, endometrial hyperplasia, uterine cancer, retinopathy

Rare: Retinal detachment, priapism

Rare: Hepatotoxicity

Rare: Cardiac arrest, cerebrovascular accident, hepatotoxicity, hallucinations, hostility, and aggression

Rare: Hypersensitivity

Rare: Bowel obstruction, cerebrovascular accident, bronchospasm

Rare: AMI, thrombocytopenia, hepatitis, PE, hypersensitivity, death, slowed or difficult breathing when used in combination with opioids

Rare: Tachycardia, QTc prolongation, angioedema, hallucinations

Rare: Erythema multiforme, Stevens-Johnson syndrome, hypohidrosis, increased body temperature, metabolic acidosis, liver failure, glaucoma, myopia, suicidal ideation, visual field defects

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause dizziness or somnolence.

Counseling: If taking as needed, take 30 min prior to anticipated sexual activity. Do not take more frequently than once q24h. Avoid driving or other activities that require mental alertness until the drug’s effects have been determined. Seek medical attention if severe skin rash, chest pain, erection lasting >4 h, tinnitus, dizziness, or shortness of breath.

Counseling: Be aware of symptoms of thrombotic events (shortness of breath, leg pain) and report to HCP. Hot flashes and other vasomotor symptoms are common and can be managed with SSRIs, including venlafaxine, discuss with your HCP if symptoms are bothersome. Do not take OTC medications that contain estrogenic compounds (black cohosh).

Counseling: Administer 30 min after same meal daily as fasting increases bioavailability by 30%. Avoid activities requiring coordination until drug effects are realized, as drug may cause vertigo or dizziness. Rise slowly from a sitting/lying position, as this drug may cause orthostatic hypotension. Syncope or loss of consciousness is possible with 1st dose or dose increases, especially if in an upright position.

Counseling: void activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness and somnolence. Rise slowly from a sitting/lying position, as this drug may cause orthostatic hypotension. May experience syncope or loss of consciousness with 1st dose. Take drug at bedtime to minimize side effects, especially the 1st dose. Avoid sudden discontinuation of drug, as this may cause rebound HTN. Avoid alcohol while taking this drug.

Counseling: Gel to be applied to clean, dry, intact skin of the shoulders and upper arms and/or abdomen but should not be applied to genitals. Gel should be allowed to dry well; swimming and showering should be avoided for 5-6 h after application. Patients should keep application site covered, as direct skin contact can transfer drug to others. Virilization has been reported in children who were secondarily exposed to testosterone gel (coming in contact with bare skin around gel application site). Male patients should report too frequent or persistent erections. Female sexual partners of patients using drug should report male-like changes. Do not use higher doses than you have been prescribed, or combine with other anabolic steroids, serious adverse effects can occur. Seek medical attention if chest pain, shortness of breath, signs of stroke, or behavioral changes.

Counseling: Wash your hands and remove contact lenses before using the medicine. For administration of Lumigan, lie down or tilt head back. With index finger, pull down the lower lid of eye to form a pocket. Hold the dropper close to eye with the other hand. Drop the correct number of drops into the pocket made between lower lid and eyeball. Gently close eyes. Place index finger over the inner corner of eye for 1 min. Do not rinse or wipe the dropper or allow it to touch anything, including eye. Put the cap on the bottle right away. Separate from other eye drops by 5 min. Reinsert contact lens after 15 min.

Counseling: Advise patients that this drug is not indicated for acute bronchospasm (rescue therapy). This drug may cause increased HR, dry mouth, constipation, urinary difficulty and retention, respiratory tract infection, and sinusitis. Warn patients that the drug capsules are for inhalation only and are not to be swallowed; instruct patients on the use of the inhalation device. When using ___, patients should inhale the contents of each capsule twice to ensure drug delivery. Maximum benefit in asthma may not be seen for 1-2 mo.

Counseling: Be cautious of risk of dizziness and somnolence when initiating therapy; do not drive until effects of drug are known. Rise slowly from a lying/sitting position, as this drug may cause hypotension. May cause xerostomia (dry mouth) and asthenia (weakness).

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause blurred vision, dizziness, and drowsiness. Swallow extended-release capsule whole; do not crush, break, or chew. In the presence of a high environmental temperature, heat prostration can occur with drug use (fever and heat stroke due to decreased sweating). If symptoms occur, the drug should be discontinued and supportive measures instituted.

Counseling: Avoid activities requiring mental alertness and coordination until drug effects are realized. Drug may cause dizziness and somnolence, especially if taken with alcohol or other CNS depressants. May cause diplopia, nervousness, confusion, and many other CNS effects. Do not discontinue drug abruptly, as this may cause increased seizure activity. Seek medical attention for new eye problems or high body temperature. May decrease sweating; avoid hot temperatures (including hot tubs and saunas). Maintain adequate fluid intake to minimize the risk of kidney stones. Instruct females on estrogen-progestin contraceptives to use an additional form of contraception due to decreased effectiveness of oral contraceptives. Take a missed dose as soon as possible, if >1 dose is missed, consult HCP.

Pearls: ___ is also available in formulations for injectable administration, and as an oral dosage form in combination with naproxen. These agents are not for prophylaxis; only for the treatment of acute migraine headache. Several serotonin agonists (___) exist for migraine, administered via a variety of routes (oral, inhaled, and injected). Each differs in onset and duration of action. If 1 agent is ineffective at max dose, recommend changing agents or route. ___ is approved in the SUBQ and nasal routes for children, oral tablet was ineffective in clinical trials. Repeat dosing not recommended for pediatric patients.

Pearls: The choice between ___, ___, ___, and ___ is largely one of patient preferences; tadalafil may be preferred in those desiring “full-day coverage.” Sexual stimulation is required to initiate the local release of NO; the inhibition of PDE5 has no effect in the absence of sexual stimulation. Many antidepressant and antihypertensive agents cause erectile dysfunction, assess and consider discontinuing. Advise patients that lifestyle modifications (stopping smoking, weight loss) can also improve sexual functioning. Adcirca is FDA approved for pulmonary artery HTN; Cialis is FDA approved for erectile dysfunction.

Pearls: The role of CYP2D6 polymorphisms in ___ response is controversial; data from some clinical trials suggest poor metabolizers have poorer response, while large epidemiologic studies show little, if any effect. Aromatase inhibitors are both more effective and have fewer adverse effects and have largely replaced___ for the treatment of breast cancer among post-menopausal women. ___ has an indication for preventing breast cancer in women at high risk but is rarely used due to adverse effects.

Pearls: Alpha-blockers are drugs of first choice for BPH, as treatment effects are observed within days. Second generation alpha-blockers, including ___, have longer half-lives allowing once daily dosing. ___ has greater prostate selectivity which results in hypotension less often than with other agents.

Pearls: ___ guidelines do not recommend the use of terazosin, or other alpha-blockers, for the treatment of HTN. Clinical use should be restricted to the management of BPH. However, ___ and ___, which are prostate-selective, result in a lower incidence of hypotension and are preferred over terazosin for BPH management.

Pearls: In addition to topical dosage forms (gel and patch), other dosage forms include subcutaneous implants and injectable, which are indicated for delayed puberty, breast cancer, female-to-male gender identity disorder, and others. Avoid other medications containing ___, including those purchased without a prescription in health food stores or on the Internet. The patch may contain metal; remove prior to MRIs. ___ has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids. If ___ abuse is suspected, check serum ___ concentrations to ensure they are within therapeutic range and consider ___ abuse in men presenting with serious cardiovascular or psychiatric symptoms. Under REMS program requirements.

Pearls: Systematic absorption occurs and can cause systemic adverse effects. Topical prostaglandins are usual drugs of first choice, although beta blockers can be used as initial therapy in patients who are not able to tolerate prostaglandins.

Pearls: Paradoxical bronchospasm has occurred with tiotropium; when it occurs, therapy should be permanently discontinued. ___ indicated for COPD only. Respimat indicated for both COPD and asthma.

Pearls: While this drug may be taken with or without food, patients should take the drug in the same way (fasting or fed) every time to avoid inconsistent absorption patterns and resulting changes in efficacy and adverse effects. Effect of food on extent of absorption differs for tablets and capsules. Abrupt discontinuation can cause rebound HTN and tachycardia. Taper dose by 2-4 mg/d if used at high dose (20-28 mg daily) or for an extended period of time. Should avoid concurrent use with opioids. Capsules and tablets are not interchangeable.

Pearls: May note decline in cognitive function, particularly in elderly. Lifestyle changes can also improve urinary symptoms. Patients should lose weight and avoid beverages containing alcohol or caffeine. Long-acting product is generally better tolerated.

Pearls: When adjusting dose, make small changes slowly (“start low and go slow”) to avoid acute adverse effects. Avoid alcohol use within 6 h of ___ to prevent dose dumping.