1. Drugs

2. Thyroid Medications Synthroid -Levothyroxine Indications – Hypothryroidism Armour Thyroid – Hypothyroidism

3. Thyroid medications Synthroid – Side effects Fatigue, increased appetite, weight loss, excessive sweating, anxiety, muscle weakness, tachycardia, menstrual irregularities, impaired fertility

4. Armour Thyroid – Side effects Itching, swelling, dizziness, trouble breathing, mental/mood changes, irregular heartbeat

5. Lipid lowering agents Crestor- Rosuvastatin – Mechanism of Action Crestor is a selective and competitive inhibitor of HMG- CoA reductase, the rate-limiting step enzyme that converts 3-hyrdoxy-3methylglutaryl coenzyme A to mevalonate, a precursor of cholesterol. First it increases the number of hepatic LDL receptors on the cell-surface to enhance uptake and catabolism of LDL. Second Crestor inhibits hepatic synthesis of LDL which reduces the total number of LDL particles

6. Lipid lowering agents Crestor- Rosuvastatin – Indications Primary Prevention of Cardiovascular Disease Hypertriglyceridemia Hyperlipidemia

7. Lipid lowering agent Lipitor –Atorvastatin – Mechanism of Action Lipitor is a selective and competitive inhibitor of HMG- CoA reductase, the rate-limiting step enzyme that converts 3-hyrdoxy-3methylglutaryl coenzyme A to mevalonate, a precursor of cholesterol Lipitor lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of hepatic LDL receptors on the cell surface to enhance the uptake of catabolism of LDL

8. Lipitor – Atorvastatin – Indications Prevention of Cardiovascular disease Hyperlipidemia

9. Proton pump inhibitor Dexilant- dexlansoprazole – Mechanism of action Dexilant suppresses gastric acid secretion by specific inhibition of (H+,K+) ATPase at the secretory surface of the gastric parietal cell. (are cells that secrete hydrochloric acid, found in the body of the stomach) Because this enzyme is regarded as the acid(-proton) pump, dexilant has been characterized as a gastric proton-pump inhibitor in that it blocks that final step of acid production

10. Proton pump inhibitor Dexilant –dexlansoprazole – Indications Maintain healing of erosive esophagitis (up to 6 months) Heartburn Symptomatic non-erosive gastroesophageal reflux disease (for 4 weeks)

11. Proton pump inhibitor Nexium- esomeprazole – Mechanism of Action Nexium is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of H+/K= - ATPase in the gastric parietal cell.(are cells that secrete hydrochloric acid, found in the body of the stomach) By active specifically nexium blocks the final step in acid production, thus reducing gastric acidity

12. Nexium-esmoprazole – Indications H. Pylori eradication – Nexium/amoxicilln/clarithromycin Short treatment of heartburn in adults and children 1 year and older Maintenance of Healing of erosive espophagitis

13. Bronchodilator Proventil HFA-albuterol sulfate – Indication PROVENTIL HFA Inhalation Aerosol is indicated in adults and children 4 years and older for the treatment or prevention of bronchospasm with reversible obstructive airway disease and for the prevention of exercise-induced bronchospasm. – Side Effects Tachycardia,(explain why) inhalation taste sensations, nausea, vomiting – Counseling/patient tips BREATHE OUT FULLY THROUGH THE MOUTH, expelling as much air from your lungs as possible. HOLD YOUR BREATH AS LONG AS POSSIBLE, up to 10 seconds. Before breathing out

14. Bronchodilator Ventolin-Albuterol Sulfate – Indication VENTOLIN HFA (albuterol sulfate inhalation aerosol) is indicated for the treatment or prevention of bronchospasm in patients 4 years of age and older with reversible obstructive airway disease VENTOLIN HFA (albuterol sulfate inhalation aerosol) is indicated for the prevention of exercise-induced bronchospasm in patients 4 years of age and older. – Side Effects Throat irritation, cough, hypokalemia – Counseling/patient tips Prime VENTOLIN HFA (albuterol sulfate inhalation aerosol) before using for the first time, when the inhaler has not been used for more than 2 weeks, or when the inhaler has been dropped. To prime VENTOLIN HFA (albuterol sulfate inhalation aerosol), release 4 sprays into the air away from the face, shaking well before each spray.

15. Beta 2 -adrenergic receptor agonist Xopenex- Levalbuterol Sulfate – Mechanism of action Levalbuterol relaxes the smooth muscles of all airways, from the trachea to the terminal bronchioles. Levalbuterol acts as a functional antagonist to relax the airway irrespective of the spasmogen involved, thus protecting against all bronchoconstrictor challenges. – Indications Xopenex inhalation solution is indicated for the treatment or prevention of brochospasm in adults, adolescents, and children 6 years of age and older with reversible obstructive airway disease – Side Effects diarrhea, dry mouth, dry throat, chest pain

16. Advair -fluticasone propionate and salmeterol (inhalation powder) ADVAIR DISKUS is a combination product containing a corticosteroid and a Long Acting Beta 2 adrenergic Agonist ADVAIR HFA is a combination product containing a corticosteroid and a LABA indicated for treatment of asthma in patients aged 12 years and older. Important limitation: Not indicated for the relief of acute bronchospasm. (1) Indications for Advair Diskus – Treatment of asthma in patients aged 4 years and older. – Maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD) – Important limitation: Not indicated for the relief of acute bronchospasm Indication for Advair HFA – Treatment of asthma in patients aged 12 years and older. – Important limitation: Not indicated for the relief of acute bronchospasm. Side effects – Asthma: Upper respiratory tract infection or inflammation, pharyngitis, oral candidiasis, bronchitis, cough, headaches, nausea and vomiting. – COPD: Pneumonia, oral candidiasis, throat irritation, headaches, musculoskeletal pain.

17. Advair Diskus vs Advair HFA ADVAIR DISKUS should be administered as 1 inhalation twice daily by the orally inhaled route only. ADVAIR HFA should be administered as 2 inhalations twice daily by the orally inhaled route only. Counseling/patient tips – Rinse mouth after use to prevent oral thrush

18. Symbicort-budesonide and formoterol fumarate dihydrate Symbicort is a combination product containing a corticosteriod and a long acting beta 2 adrenergic agonist Indications – Treatment of asthma in patients 12 years of age and older – Maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema – Important Indications Not indicated for the relief of acute bronchospasm

19. COMBIVENT RESPIMAT -ipratropium bromide and albuterol COMBIVENT RESPIMAT Inhalation Spray is a combination of an anticholinergic and beta2- adrenergic agonist Indication – COMBIVENT RESPIMAT is indicated for use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator (inhaler) who continue to have evidence of bronchospasm (airway narrowing) and who require a second bronchodilator. Side Effects – Cough, headache, bronchitis, nasopharyngitis

20. Dulera- mometasone furate and formoterol furate dihydrate DULERA is a combination product containing a corticosteroid and a long acting beta2-adrenergic agonist Indication – Used to control and prevent asthma symptoms such as wheezing in people 12 and older. DULERA is not a rescue inhaler and should not be used as a treatment for sudden asthma symptoms. DULERA is not for people who are well controlled on a long- term asthma-control medicine like a low to medium dose of an inhaled corticosteroid medicine, or who only need a rescue inhaler once in a while.

21. Dulera Mechanism of action of each active ingredient – Mometasone furoate is a corticosteroid demonstrating potent anti-inflammatory activity. – Formoterol fumarate is a long-acting selective beta2-adrenergic receptor agonist (beta2-agonist). Inhaled formoterol fumarate acts locally in the lung as a bronchodilator. Side effects – Nasopharyngitis, Sinusitis, headache

22. Spiriva-tiotropim bromide Spiriva comes in two different inhalation forms 1.Respimat -spray mist 2.Handihaler -inhalation powder

23. Spiriva SPIRIVA RESPIMAT is an anticholinergic – Indication The long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), and for reducing COPD exacerbations The long-term, once-daily, maintenance treatment of asthma in patients 12 years of age and older

24. Spiriva SPIRIVA HANDIHALER is an anticholinergic – Indication long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), and for reducing COPD exacerbations