NCLEX Medications Review (part 1)
Post two on recent drugs – you can find the first post here.
I hope you take at least a few hours off your studies as we have a holiday weekend.
Namzaric
Namzaric is used to treat moderate to severe dementia of the Alzheimer’s type.
Namzaric is not a cure for Alzheimer’s disease. This condition will progress over time, even in people who take donepezil.
How to Take
Take Namzaric at bedtime unless your doctor tells you otherwise. You may take Namzaric with or without food. Do not crush, chew, or break an extended-release Namzaric capsule. Swallow it whole.
Dosage
Usual Adult Dose of Namzaric for Alzheimer’s Disease:
Patients stabilized on memantine (10 mg twice a day or 28 mg ER once a day) and donepezil 10 mg once a day:
-Memantine 28 mg ER-donepezil 10 mg orally once a day in the evening
Comments: This drug should be initiated the day following the last dose of memantine and donepezil administered separately.
Use:
Treatment of moderate to severe dementia of the Alzheimer’s type in patients stabilized on
-Memantine (10 mg twice a day or 28 mg ER once a day) and donepezil 10 mg once a day, or
-Memantine (5 mg twice a day or 14 mg ER once a day) and donepezil 10 mg once a day in patients with severe renal impairment
Side Effects
Stop using this medicine and call your doctor at once if you have:
- severe or ongoing vomiting;
- a light-headed feeling, like you might pass out;
- slow heartbeats;
- seizure (convulsions);
- painful or difficult urination;
- new or worsening breathing problems; or
- signs of stomach bleeding – severe heartburn or stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.
Common Namzaric side effects may include:
- nausea, vomiting, diarrhea, loss of appetite;
- headache;
- dizziness; or
- easy bruising.
MyBreo Breo Ellipta
Copd – Once-daily BREO 100/25 is a prescription medicine used long term to treat chronic obstructive pulmonary disease (COPD) for better breathing and fewer flare-ups. BREO is not used to relieve sudden breathing problems and won’t replace a rescue inhaler.
Asthma – Once-daily BREO is a prescription medicine for adults whose asthma is not well controlled on a long-term asthma control medicine, like an inhaled corticosteroid. BREO is not used to relieve sudden breathing problems and won’t replace a rescue inhaler.
How to Take
The usual dose of Breo Ellipta is 1 inhalation per day. Use the medicine at the same time each day, and not more than once in a 24-hour period.
To reduce the chance of developing a yeast infection in your mouth, rinse with water after using your inhaler. Do not swallow.
Dosage
Fluticasone 100 mcg-vilanterol 25 mcg (1 inhalation) orally once a day
Maximum dose: 1 inhalation in 24 hours
Comments:
-Breo Ellipta is not indicated for the relief of acute bronchospasm.
-Only fluticasone 100 mcg-vilanterol 25 mcg is indicated for the treatment of COPD.
-If shortness of breath occurs in the period between doses, use an inhaled, short-acting beta2-agonist for immediate relief.
Side Effects
Call your doctor at once if you have:
- wheezing, choking, or other breathing problems after using this medication;
- chest pain, shortness of breath, tremors, nervousness;
- feeling very weak or tired, nausea and vomiting, feeling like you might pass out;
- blurred vision, tunnel vision, eye pain, or seeing halos around lights;
- fever, chills, cough with yellow or green mucus;
- sores or white patches in your mouth and throat, pain when swallowing;
- low potassium – leg cramps, constipation, irregular heartbeats, fluttering in your chest, extreme thirst, increased urination, numbness or tingling, muscle weakness or limp feeling; or
- high blood sugar – increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss.
Common Breo Ellipta side effects may include:
- headache; or
- runny or stuffy nose, sore throat.
Contrave (bupropion and naltrexone)
Contrave contains a combination of bupropion and naltrexone. Bupropion is an antidepressant medicine that can also decrease appetite. Naltrexone is usually given to block the effects of narcotics or alcohol in people with addiction problems. Naltrexone may also curb hunger and food cravings.
Contrave is used to help manage weight in obese or overweight adults with weight-related medical problems. This medicine is used together with diet and exercise.
How to Take
Do not crush, chew, or break the tablet. Swallow it whole. Do not take more than 2 tablets at once.
Do not take Contrave with a high-fat meal, or you may be more likely to have a seizure. If you have a seizure while taking Contrave, you may never be able to take it again.
If you need to use narcotic medicine for any reason (such as pain, surgery, or treatment for drug addiction) you may need to stop taking Contrave for a short time. You also may need to use a lower dose of any narcotic medicine you have used in the past. Follow your doctor’s dosing instructions very carefully.
Store Contrave at room temperature away from moisture and heat.
If you have not lost at least 5% of your starting weight after 16 weeks of treatment, this medicine may not be right for you.
Dosage
Initial dose:
-Week 1: One tablet (8 mg naltrexone/90 mg bupropion) orally once in the morning; then
-Week 2: One tablet orally twice a day (once in the morning and once in the evening); then
-Week 3: Two tablets orally in the morning and one tablet orally in the evening
Maintenance dose: Week 4 and onward: Two tablets orally twice a day (morning and evening)
Maximum dose: Two tablets orally twice a day
Comments:
-Discontinue therapy if a patient has not lost at least 5% of baseline body weight after 12 weeks at the maintenance dose.
-The effect of this drug on cardiovascular morbidity and mortality has not been established.
-The safety and effectiveness of this drug in combination with other products intended for weight loss, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been established.
Use:
An adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:
-30 kg/m2 or greater (obese) or
-27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia)
Side Effects
Do not use Contrave if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
Stop taking Contrave and call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, depression, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
Stop using this medicine and call your doctor at once if you have:
- seizure (convulsions);
- blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
- manic episodes – racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, being irritable or talkative;
- liver problems – nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
- dangerously high blood pressure – severe headache, pounding in your neck or ears, severe chest pain, shortness of breath; or
- severe skin reaction – fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Older adults may be more likely to have certain side effects.
Common Contrave side effects may include:
- nausea, vomiting, diarrhea, constipation;
- headache, dizziness;
- dry mouth; or
- sleep problems (insomnia).
Neulasta (pegfilgrastim)
Neulasta (pegfilgrastim) is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection.
Neulasta is used to prevent neutropenia, a lack of certain white blood cells caused by receiving chemotherapy.
How to Take
Neulasta is injected under the skin. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
Neulasta is usually given once per chemotherapy cycle. This medication should not be given within 14 days before or 24 hours after you receive chemotherapy.
Do not shake the prefilled syringe. Prepare your dose only when you are ready to give an injection. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
The Neulasta On-body Injector is a special device placed on the skin that delivers your Neulasta dose at a specific time. Read and carefully follow all instructions for using this product. You will need to wear the device for 27 hours before the dose begins. The timed dose will then be released from the device slowly over a 45-minute period. While wearing the On-body Injector, you or a caregiver will need to check the device to make sure it is working properly.
Each prefilled Neulasta syringe or On-body Injector is for one use only. Throw away after one use, even if there is still some medicine left in it after injecting your dose.
Dosage
Usual Adult Dose for Neutropenia Associated with Chemotherapy:
6 mg subcutaneously once per chemotherapy cycle, beginning 24 to 72 hours after completion of chemotherapy
Usual Pediatric Dose for Neutropenia Associated with Chemotherapy:
Based on limited studies:
1 to 12 years old: 100 mcg/kg (maximum dose: 6 mg) once per chemotherapy cycle, beginning 24 to 72 hours after completion of chemotherapy
13 to 18 years old and greater than 45 kg: 6 mg once per chemotherapy cycle, beginning 24 to 72 hours after completion of chemotherapy
Side Effects
To make sure you can safely use Neulasta, tell your doctor if you have any of these other conditions:
- sickle cell disorder;
- kidney disease;
- chronic myeloid leukemia;
- myelodysplasia (also called “preleukemia”); or
- a latex allergy.
Call your doctor at once if you have:
- sudden or severe pain in your left upper stomach spreading up to your shoulder;
- rapid breathing, feeling short of breath;
- bruising, swelling, or a hard lump where the medicine was injected;
- kidney problems – little or no urination, pink or dark urine, swelling in your feet or ankles, feeling tired or short of breath; or
- low white blood cell counts – fever, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough.
Common Neulasta side effects may include:
- bone pain, muscle aches;
- pain in your arms or legs; or
- pain and redness where the injection was given.
Entresto (sacubitril and valsartan)
Entresto contains a combination of sacubitril and valsartan. Sacubitril is a blood pressure medicine. It works by increasing the levels of certain proteins in the body that can dilate (widen) blood vessels. This helps lower blood pressure by reducing sodium levels.
Valsartan is an angiotensin II receptor blocker (sometimes called an ARB). Valsartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.
Entresto is used in certain people with chronic heart failure. This medicine helps lower the risk of needing to be hospitalized when symptoms get worse, and helps lower the risk of death from heart failure.
Entresto is usually given together with other blood pressure medications.
How to Take
You may take Entresto with or without food. Take the medicine at the same time each day.
Your blood pressure will need to be checked often. Your kidney function may also need to be checked.
Store Entresto in the original container at room temperature away from moisture and heat.
Dosage
Usual Adult Dose for Congestive Heart Failure:
Initial dose: Sacubitril 49 mg-Valsartan 51 mg orally twice a day
Maintenance dose: Sacubitril 97 mg-Valsartan 103 mg orally twice a day
Side Effects
Also call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- extreme tiredness;
- high potassium – slow heart rate, weak pulse, muscle weakness, tingly feeling; or
- kidney problems – little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath.
Common Entresto side effects may include:
- dizziness; or
What other drugs will affect Entresto?
Tell your doctor about all your current medicines and any you start or stop using, especially:
- aliskiren;
- lithium;
- any other heart or blood pressure medicines;
- a diuretic or “water pill”;
- medicine or mineral supplements that contain potassium; or
- NSAIDs (nonsteroidal anti-inflammatory drugs) – aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
Kyleenah (levonorgestrel intrauterine system)
Levonorgestrel is a female hormone that can cause changes in your cervix, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus. Levonorgestrel intrauterine system is a plastic device that is placed in the uterus where it slowly releases the hormone to prevent pregnancy for 3 to 5 years.
How to Take
Levonorgestrel intrauterine system is a T-shaped plastic device that is inserted through the vagina and placed into the uterus by a doctor. The device is usually inserted within 7 days after the start of a menstrual period.
You may feel pain or dizziness during insertion of the IUD. You may also have minor vaginal bleeding. Tell your doctor if you still have these symptoms longer than 30 minutes.
The levonorgestrel device should not interfere with sexual intercourse, wearing tampons, or using other vaginal medications recommended by your doctor.
You may have irregular periods during the first 3 to 6 months of use. Your flow may be lighter or heavier, and you may eventually stop having periods after several months. Call your doctor if you miss a period or think you might be pregnant.
Your device may be removed at any time you decide to stop using birth control. The Mirena or Kyleena intrauterine system must be removed at the end of the 5-year wearing time. The Skyla or Liletta device must be removed after 3 years. Your doctor can insert a new device at that time if you wish to continue using this form of birth control. Only your doctor should remove the IUD. Do not attempt to remove the device yourself.
Side Effects
Call your doctor at once if you have:
- severe cramps or pelvic pain, pain during sexual intercourse;
- extreme dizziness or light-headed feeling;
- severe migraine headache;
- heavy or ongoing vaginal bleeding, vaginal sores, vaginal discharge that is watery, foul-smelling discharge, or otherwise unusual;
- pale skin, weakness, easy bruising or bleeding, fever, chills, or other signs of infection;
- sudden numbness or weakness (especially on one side of the body), confusion, problems with vision, sensitivity to light;
- jaundice (yellowing of the skin or eyes); or
- signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Common side effects may include:
- pelvic pain, vaginal itching or infection, irregular menstrual periods, changes in bleeding patterns or flow;
- stomach pain, nausea, vomiting, bloating;
- headache, depression, mood changes;
- back pain, breast tenderness or pain;
- weight gain, acne, changes in hair growth, loss of interest in sex; or
- puffiness in your face, hands, ankles, or feet.
Victoza (liraglutide)
Victoza (liraglutide) is similar to a hormone that occurs naturally in the body and helps control blood sugar, insulin levels, and digestion.
Victoza is used together with diet and exercise to treat type 2 diabetes.
Victoza is usually given after other diabetes medicines have been tried without success. Victoza is not for treating type 1 diabetes.
How to Take
Victoza is usually given once per day. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use Victoza in larger or smaller amounts or for longer than recommended.
Victoza is injected under the skin at any time of the day, with or without a meal. You will be shown how to use injections at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles and syringes.
Victoza comes in a prefilled injection pen. Ask your pharmacist which type of needles are best to use with your pen.
Your care provider will show you the best places on your body to inject Victoza. Use a different place each time you give an injection. Do not inject into the same place two times in a row.
Dosage
Initial dose: 0.6 mg subcutaneously once a day for 1 week; this dose is intended to reduce gastrointestinal symptoms and is not an effective dose for glycemic control.
Maintenance dose: Inject 1.2 mg subcutaneously once a day; if acceptable glycemic control is not achieved, may increase to 1.8 mg subcutaneously once a day
Maximum dose: 1.8 mg once a day
Comments:
-Consider dose reduction of the insulin secretagogue to reduce the risk of hypoglycemia.
-This drug is not recommended as a first-line therapy for patients with inadequate glycemic control on diet and exercise.
Side Effects
Call your doctor at once if you have:
- racing or pounding heartbeats;
- sudden changes in mood or behavior, suicidal thoughts;
- severe ongoing nausea, vomiting, or diarrhea;
- signs of a thyroid tumor – swelling or a lump in your neck, trouble swallowing, a hoarse voice, feeling short of breath;
- gallbladder problems – fever, upper stomach pain, clay-colored stools, jaundice (yellowing of your skin or eyes);
- symptoms of pancreatitis – severe pain in your upper stomach spreading to your back, nausea with or without vomiting, fast heart rate;
- severely low blood sugar – extreme weakness, confusion, tremors, sweating, fast heart rate, trouble speaking, nausea, vomiting, rapid breathing, fainting, and seizure (convulsions); or
- kidney problems – little or no urination; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath.
Common Victoza side effects may include:
- low blood sugar;
- nausea (especially when you start using liraglutide), vomiting, stomach pain;
- upset stomach, loss of appetite;
- headache, dizziness, tiredness; or
- diarrhea, constipation.
Keytmda (pembrolizumab)
Keytruda (pembrolizumab) is a cancer medicine that interferes with the growth and spread of cancer cells in the body.
Keytruda is used to treat advanced skin cancer (melanoma) that has spread to other parts of the body or cannot be surgically removed.
Keytruda is also used to treat a certain type of non- small cell lung cancer, if your tumor has a specific genetic marker for which your doctor will test. It is also used to treat head and neck cancer that has spread to other parts of the body, or has come back after prior treatment.
Keytruda is also used treat classical Hodgkin lymphoma in adults and children that has not responded to other treatments, or has relapsed.
Keytruda is often given after other cancer medicine has been tried without success.
How to Take
Keytruda is injected into a vein through an IV. A healthcare provider will give you this injection.
Keytruda is usually given once every 3 weeks. Your doctor will determine how long to treat you with this medicine. Follow your doctor’s dosing instructions.
Before you start treatment, your doctor will perform tests to make sure Keytruda is the best treatment for your type of skin cancer.
Dosage
Usual Adult Dose for Melanoma – Metastatic:
2 mg/kg IV infusion over 30 minutes
Duration of therapy: Administer every 3 weeks until disease progression or unacceptable toxicity.
Uses: Treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab and a BRAF inhibitor if BRAF V600 mutation positive.
Side Effects
Call your doctor at once if you have:
- new or worsening cough, chest pain, feeling short of breath;
- pale skin, easy bruising or bleeding;
- severe muscle weakness, severe or ongoing muscle aches, joint pain;
- diarrhea or increased stools, severe stomach pain, stools that contain mucus, black/bloody or tarry stools;
- low levels of sodium in the body – confusion, slurred speech, severe weakness, loss of coordination, feeling unsteady;
- signs of a hormonal disorder – frequent or unusual headaches, vision problems, feeling light-headed or very tired, rapid heartbeats, mood or behavior changes, hoarse or deepened voice, increased hunger or thirst, increased urination, constipation, hair loss, sweating, feeling cold, weight gain, or weight loss;
- symptoms of a kidney problem – urinating more or less than usual, pelvic pain, vomiting, swelling in your ankles or feet, pain or burning when you urinate, bloody or cloudy urine; or
- liver problems – loss of appetite, upper stomach pain, easy bruising or bleeding, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.
Common Keytruda side effects may include:
- nausea, vomiting, stomach pain, loss of appetite, diarrhea, constipation;
- low sodium levels, abnormal liver function tests;
- itching or rash;
- fever, cough, feeling short of breath;
- joint pain; or
- feeling tired.
