Top 20 Prescribed Drugs 2013                                                                                                                     DEN 315

Prfersspr Marilyn Cortell,RDH,MS,FAADH

Fannyeu Liou

Yineeta Chitlall

Olha vashkeych

Qing Jiang Huang

1. Abilify (ARIPiprazole):

• Pharmacologic category: Antipsychotic agent, Atypical
• Drug use: bipolar, irritability associated with autistic disorder, major depressive disorder, and schizophrenia.
• MOA: quinolinon antipsychotic which exhibits high affinity for D2 and D3 receptors. Moderate affinity for the serotonin reuptake transporter.
• Adverse Effects: >10% Headache 27%, extrapyramidal reaction (does related) 8-26%, sedation 13% insomnia 18%anxity 17% chest pain 10%
• Drug Interactions: may increase the level/ effect of alcohol; CNS depressant; thalidomide; Zolpidem.

2. Nexium ( Esomeprazole):

• Pharmacologic category: Proton pump inhibitor; substituted Benzimidazole.
• Drug use: treatment for erosive esophagitis, gastroesophageal reflux disease GERD.
• MOA: proton pump inhibitor suppresses gastric acid secretion by inhibition of the H+/K+ ATPase in the gastric parietal cell.
• Adverse Effects: Headach I.v. 11%
• Drug Interactions: may increase the level; effect of Vitamin K antagonists, Voriconazole.

3. Humira ( Adalimumab):

• Pharmacologic category: Antirheumatic, Gastriubtetinal agent, Monoclonal antibody, Tumor Necrosis Factor Blocking Agent.
• Drug use: Ankylosing spondylitis. Crohn’s disease, plaque psoriasis. Psoriatic arthritis, rheumatoid arthritis and ulcerative colitis.
• MOA: recombinant monoclonal antibody that bind to human tumor necrosis factor alpha (TNF-alpha), thereby interfering with binding to TNFa receptor sites and subsequent cytokine driven inflammatory processes.
• Adverse Effects: Headache 12%, skin rash 12%, antibody development 26%, upper respiratory tract infection 17%.
• Drug Interactions: Not listed

4. Crestor(Rosuvastatin):

• Pharmacologic category: antilipemic agent, HMG CoA reeducates inhibitor
• Drug use: Treatment for hypercholesterolemia, hyperlipidemia and mixed dyslipidemia and hypertriglyceridemia.
• MOA: increase in the expression of LDL receptors on hepatocyte membranes and a stimulation of LDL catabolism.
• Adverse Effects: Myalgia 13% headache 6%
• Drug Interactions: Not listed

5. Cymbalta(Duloxetine):

• Pharmacologic category: Antidepressant, Serotinin/ Norepinephrine reuptake inhibitor
• Drug use: Treatment for hypercholesterolemia, hyperlipidemia and mixed dyslipidemia and hypertriglyceridemia.
• MOA: potent inhibitor of neuronal serotonin and norepinephrine reuptake and a weak inhibitor of dopamine reuptake.
• Adverse Effects: Headache 14% fatigue 11% nausea 25% xerostomia 15%
• Drug Interactions: Not listed

6. Advair Diskus (Fluticasone & Salmeterol)
   • Pharmacologic category: Beta2 Agonist
   • Drug use: maintenance treatment of asthma and COPD
   • MOA:
   • Fluticasone: anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions; extremely potent vasoconstrictive and anti-inflammatory activity.
   • Salmeterol: relaxes bronchial smooth muscle by selective action on Beta 2 receptors with little effect on heart rate.
   • Adverse effects: upper respiratory tract infection (16%-27%), headache (12%-21%)
   • Drug interaction: may increase levels/toxicity of long acting Beta2 agonists, loop diurectics, sympathomimetics, and thiazide diuretics; may decrease levels/effects of antidiabetic agents.
7. Remicade (infliximab)

• Pharmacologic category: antirheumatic, GI tract, immunosuppressant agent, tumor necrosis factor (TNF) blocking agent.
• Drug use: treatment of moderately-to-severely active rheumatoid arthritis and Crohn’s disease with inadequate response to conventional therapy.
• MOA: infliximab is a chimeric monoclonal antibody that binds to human tumor necrosis factor alpha, thereby interfering with endogenous tumor necrosis factor alpha activity.
• Adverse effects: infection (36%), upper respiratory tract infection (32%), nausea (21%), headache (18%), abscess (15%), sinusitis (14%), cough (12%), pharyngitis (12%).
• Drug interaction: because infliximab may decrease response of immune system, do not administer with vaccines containing live bacteria or viruses; combining with anakinra (kineret), abatacept (orencia) or tocilizumab (actemra) may increase risk of serious infections.

8. Spiriva (Tiotropium)

• Pharmacologic category: anticholinergic agent.
• Drug use: maintenance treatment of bronchospasm associated with COPD.
• MOA: inhibit actions of acetycholine at type 3 muscarinic receptors in bronchial smooth muscle causing bronchodilation.
• Adverse effects: upper respiratory tract infection (41%), xerostomia (5%-16%).
• Drug interaction: not listed

9. Lantus solostar/Lantus (insulin glargine)

• Pharmacologic category: insulin
• Drug use: treatment of type 1 diabetes mellitus and type 2 diabetes mellitus to improve glycemic control.
• MOA: insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats. Target organs for insulin include liver, skeletal muscle and adipose tissue.
• Adverse effects: hypoglycemia, tachycardia, fatigue, headache, mental confusion.
• Drug interaction: not listed

1. Januvia (Sitagliptin)

• Pharmacologic category: antidiabetic agent, dipeptidyl peptidase IV inhibitor
• Drug use: management of type 2 diabetes mellitus
• MOA: inhibits dipeptidyl peptidase enzyme resulting in prolonged active incretin levels.
• Adverse effects: diarrhea, constipation.
• Drug interaction: may increase levels/effects of ACE inhibitor, hypoglycemic agents; may be increased by herbs, MAO inhibitors, selective serotonin reuptake inhibitor; may be decreased by corticosteroids (orally inhaled and systemic), loop diuretics.

1. Zetia (Ezetimibe)

• Pharmacologic category: Atilipemic agent
• Drug use: Treatment of primary hypercholesterolemia
• MOA: Inhibits absorption of cholesterol at the brush border of the small intestines.
• Decreased delivery of cholesterol to the liver.
• Adverse effects: fatigue, diarrhea.
• Drug interaction: may decrease the effect/levels of Cyclosporine, levels of Ezetimibe may be increased by Cyclosporine, levels/effects of Ezetimibe may be decreased by bile acid sequestrants.

2. Methylphenidate (Concerta, Daytrana, Metadate CD, Ritalin)

• Pharmacological Category: Central nervous system stimulant
• Drug use: treatment of ADHD; symptomatic management of narcolepsy (except Concerta, Daytrana, Metadate CD, Ritalin LA, and Quillivant XR).
• MOA: Blocks the reuptake of norepinephrine and dopamine into presynaptic neurons.
• Adverse effects: hypertension (monitor blood pressure prior to using local anesthetic with vasoconstrictors), insomnia (6-13%), irritability (7%-11%), nausea 10-12%).
• Drug interactions: Avoid concomitant use with alcohol (may increase levels), inhalational anesthetics, MAO inhibitors (increase levels). Methylphenidate may increase effects of Anti-Parkinson’s agent, antipsychotics.

3. Symbicort (Budesonide and Formoterol)

• Pharmacologic Category: Beta2 Agonist, corticosteroid, inhalant
• Drug use: treatment of asthma in patient ≥12 years of age, maintenance treatment of airflow obstruction associated with COPD, bronchitis and emphysema.
• MOA: Formoterol relaxes bronchial smooth muscle by selective action on beta2 receptors.
• Adverse effects: headache (7%-11%), nasopharyngitis (7%-11%), upper respiratory infections (4%-11%), xerostomia.
• Drug interactions: not listed

4. Albuterol (ProAir HFA)

• Beta2 agonist
• Drug use: treatment or prevention of bronchospasm in patients with reversible obstructive airway disease; prevention of exercise induced bronchospasm.
• Pharmacologic Category: Androgen
• Use: replacement therapy in the treatment of delayed male puberty.
• MOA: endogenous androgen responsible for promoting the growth and development of the male sex organs and maintaining secondary sex characteristics in androgen-deficient males.
• Adverse effects: prostate specific antigen increase (5%-11%), application site pruritus (17%-37%).

5. Viagra (Sildenafil)

• Pharmacolgic Category: Phosphodiesterase-5 Enzyme inhibitor.
• Drug use: Revatio: treatment of pulmonary arterial hypertension in adults to improve exercise ability and delay clinical worsening.
• Viagra: treatment of erectile dysfunction.
• Unlabeled use: persistent pulmonary hypertension after recent left ventricular assist device placement.
• MOA: Erectile dysfunction: does not directly cause penile erections, but affects the response to sexual stimulation.
• Pulmonary arterial hypertension: inhibits PDE-5 in smooth muscle of pulmonary vasculature where PDE-5 is responsible for the adaptation of cyclic guanosine monophosphate (cGMP). Increased cGMP concentration results in pulmonary vasculature relaxation.
• Adverse effects: headache (16%-46%), dyspepsia (7%-17%), flushing (10%).
• Drug interaction: avoid concomitant use with Alprostadil, Amyl Nitrite, Boceprevir, Cobicistat, Fusidic acid, Phosphodiesterase 5 inhibitors, Pimozide, Rioclgust, Telaprevir, Vasodilators.

6. Cialis (Tadafil)

• Pharmacologic category: Phosphodiesterase-5 ezyme inhibitor.
• Drug use: signs and symptoms of benign prostatic hyplerplasia, erectile dysfunction, pulmonary arterial hypertension.
• MOA: likely due to PDE-5 mediated reduction in smooth muscle and endothelial cell proliferation, decreased nerve activity, and increased smooth muscle relaxation. PAH: pulmonary vasculature relaxation.
• Adverse effects: flushing (1-13%), headache (3%-42%), nausea (10%-11%).
• Drug interaction: Avoid concomitant use with Alprostadil, Amyl Nitrite, Fusidic acid.

7. AndroGel (testosterone)

• Pharmacologic Category: Androgen
• Drug use: Replacement therapy in the treatment of delayed male puberty.
• MOA: Endogenous androgen responsible for promoting the growth and development of the male sex organs and maintaining secondary sex characteristics in androgen-deficient males.
• Adverse effects: prostate specific antigen increase (5%-11%), application site pruritus (17%-37%).

8. Avastin ( Bevacizumab)

• Pharmacologic category: Antineoplastic agent.
• Drug use: Treatment of metastatic colon or rectal cancer, non-squamous, non-small cell lung cancer, metastatic breast cancer used as part of a combination chemotherapy regimen, glioblastoma (GBM), metastatic renal cell carcinoma.
• MOA: inhibits the biologic activity of human vascular endothelial growth factor (VEGF) in in vitro and in vivo assay systems.
• Adverse effects: hypertension, thromboembolism,pain,fatigue, headache, dizziness, abdominal pain, vomiting, stomatitis, upper respiratory infection.
• Drug interaction: No significant effects

9. Oxycontin (Oxycodone)

• Pharmacologic category: Analgesic, opioid.
• Drug use: relief of moderate to severe pain, for acute pain and in some instances of chronic cancer pain.
• MOA: Binds to opiate receptors in the CNS, causing inhibition of  ascending pain pathways, altering the perception of and response to pain, produces generalized CNS depression.
• Adverse effects: euphoria, constipation, fatigue, dizziness, nausea, vomiting, dry mouth, anxiety, itching, and sweating.
• Drug interactions: Avoid taking Oxycodone with sleeping pill, muscle relaxer, other pain medicine, or medicine for anxiety, depression, or seizures.

1. LYRICA( Pregamblin)

• Pharmacologic category: Analgesic, Anticonvulsant
• Drug use: Neuropathic pain associated with diabetic peripheral neuropathy, Postherpetic neuralgia, adjunctive therapy for adult patients with partial onset seizures, fibromyalgia, neuropathic pain associated with spinal cord injury.
• MOA: inhibit excitatory neurotransmitter release including glutamate, norepinephrine, serotonin, and dopamine.
• Adverse effects: Serious, even life-threatening, allergic reaction, suicidal thoughts or actions, swelling of your hands, legs and feet, dizziness and sleepiness.
• DRUG INTERACTIONS: Avoid use with Azelastine,Thalidomide, Pregablin may increase levels/effects of : Alcohol, Azelastine(nasal), CNS depressants, Hydrocodone, Selective Serotonin Reuptake Inhibitors, Zolpidem