VMRC Unique Drugs

• GlucaGen, Gvoke

  
  

  Generic: glucagon

  Class: hypoglycemia antidote, diagnostic agent

  Indication: hypoglycemia in pts with diabetes ages 4 and above

  Contraindication: pheochromocytoma, insulinoma

  Black Box: N/A

  Beer's: No

  Counseling for drug class: may have to be given by someone else, if no response within 15 min can give another dose, administer oral carbs asap after response to treatment

  Counseling for drug: nasal spray contains only one dose and can't be reused, is given in one side of nostril but does not need to be inhaled, keep in shrink wrap tube until ready to use
• Kelnor 1/35, Kelnor 1/50, Zovia 1/35

  
  

  Generic: ethinyl estradiol and ethynodiol diacetate

  Class: contraceptive, estrogen and progestin combination

  Indication: pregnancy prevention

  Contraindication: pregnancy, thromboembolic disorders, breast cancer

  Black Box: smoking, cardiovascular events

  Beer's: Yes

  Counseling for drug class: bleeding irregularities, cervical cancer, Don't skip doses even if no sexual intercourse, may experience high BP

  Counseling for drug: d/c if jaundice, visual disturbances, migraines occur. May cause dark patches of skin on face, take with food if upset stomach
• Relafen DS

  
  

  Generic: nabumetone

  Class: NSAID

  Indication: OA, RA

  Contraindication: CABG surgery

  Black Box: cardiovascular risk, MI, Stroke, GI bleeding, ulceration, intestine perforation

  Beer's: yes

  Counseling for drug class: use lowest possible dose for shortest duration, take with food if upset stomach, can cause ulcer/bleeding in stomach and intestines, watch for black tarry stool

  Counseling for drug: take with full glass of water, protect from light, pts <50kg are less likely to require >1g/day
• Erivedge

  
  

  Generic: vismodegib

  Class: antineoplastic agent, hedgehog pathway inhibitor

  Indication: metastatic or locally advanced basal cell carcinoma

  Contraindication: N/A

  Black Box: embryofetal toxicity

  Beer's: no

  Counseling for drug class: verify pregnancy status within 7 days before therapy initiation, store at room temp, high alert medication

  Counseling for drug: administer with or without food, swallow whole, not for pediatric use
• Saphris, Secaudo

  
  

  Generic: asenapine

  Class: antimanic agent, 2nd generation antipsychotic

  Indication: BPD (SL tab), schizophrenia (SL tab & patch)

  Contraindication: severe hepatic impairment (child-pugh class C)

  Black Box: increased mortality in elderly patients with dementia-related psychosis

  Beer's: Yes

  Counseling for drug class: gradually taper to avoid withdrawal, monitor for EPS, may change blood sugar levels

  Counseling for drug: 1 patch at a time, SL can lead to numb/tingling tongue, change in taste, don't eat or drink for at least 10 min
• Tranxene-T

  
  

  Generic: clorazepate

  Class: antiseizure agent, benzodiazepine

  Indication: anxiety disorder, focal onset seizures

  Contraindication: acute narrow-angle glaucoma

  Black Box: risks from concomitant use with opioids, abuse, misuse, and addition, dependence and withdrawal reactions

  Beer's: yes

  Counseling for drug class: avoid for anxiety treatment in patients planning to get pregnant, gradually taper, avoid use in patients with history of substance misuse

  Counseling for drug: FDA approved for symptomatic relief of acute alcohol withdrawal, take with food or water, store at room temp
• Gemtesa

  
  

  Generic: vibegron

  Class: beta 3 agonist

  Indication: overactive bladder

  Contraindication: N/A

  Black Box: N/A

  Beer's: no

  Counseling for drug class: may increase blood pressure, cause urinary retention or angioedema, don't use in severe impairment and ESRD

  Counseling for drug: swallow whole with full glass of water, tabs can be crushed and mixed with apple sauce, with or without food, use with caution in patients with bladder outlet obstruction
• Katerzia, Norliqva, Norvasc

  
  

  Generic: amlodipine

  Class: antihypertensive, DHP-CCB, antianginal agent

  Indication: angina, hypertension

  Contraindication: N/A

  Black Box: N/A

  Beer's: no

  Counseling for drug class: symptomatic hypotension, caution in patients with hepatic impairment, with or without food

  Counseling for drug: monitor for symptoms of peripheral and pulmonary edema, Katerzia oral suspension, shake well
• Motpoly XR, Vimpat

  
  

  Generic: lacosamide

  Class: antiseizure agent

  Indication: focal onset seizure, primary generalized tomic-clonic seizures

  Contraindication: N/A

  Black Box: N/A

  Beer's: yes

  Counseling for drug class: avoid abrupt discontinuation, gradually withdraw over more than 1 week, caution in patients with renal or hepatic impairment, suicidal ideation or tendencies

  Counseling for drug: oral solution to be administered with a calibrated measuring device, swallow tabs whole, blurry vision and diplopia may occur
• Kerendia

  
  

  Generic: finerenone

  Class: nonsteroidal mineralocorticoid (aldosterone) receptor

  Indication: CKD associated with T2DM

  Contraindication: adrenal insufficiency

  Black Box: N/A

  Beer's: yes

  Counseling for drug class: hyperkalemia, avoid GFJ, avoid breastfeeding during and 1 day after last dose

  Counseling for drug: tabs can be crushed and mixed with water or soft foods, don't take 2 doses on same day, if miss dose administer asap but only on the same day missed
• Bydureon BCise, Byetta 5mcg pen, Byettea 10mcg pen

  
  

  Generic: exenatide

  Class: GLP-1 receptor agonist, antidiabetic agent

  Indication: T2DM

  Contraindication: history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, history of drug-induced immune-mediated thrombocytopenia

  Black Box: risk of thyroid c-cell tumors

  Beer's: No

  Counseling for drug class: not recommended for patients with T2DM trying to get pregnant, diarrhea, N/V, incidence of gallbladder disease

  Counseling for drug:
• Elixophyllin, Theo-24

  
  

  Generic: theophylline

  Class: non-selective phosphodiesterase enzyme inhibitor

  Indication: reversible airflow obstruction

  Contraindication: allergy to corn-related products

  Black Box: N/A

  Beer's: no

  Counseling for drug class: may exacerbate seizure disorder, use with extreme caution in older adults, fast/abnormal heartbeat, high blood sugar, confusion

  Counseling for drug: ethanol decreases theophylline clearance which can lead to severe and potentially fatal toxicity
• Santyl

  
  

  Generic: collagenase

  Class: topical debridement enzyme

  Indication: dermal ulcers

  Contraindication: N/A

  Black Box: N/A

  Beer's: no

  Counseling for drug class: topical use only, look for allergic reactions, apply only to area of wound

  Counseling for drug: erythema in surrounding tissue, monitor debilitated patients for systemic bacterial injections, collagenase is indicated in stage 3 and 4 pressure ulcers in older adults
• Sulindac

  
  

  Generic: sulindac

  Class: nonopioid analgesic, NSAID

  Indication: acute gouty arthritis, ankylosing spondylitis arthritis, bursitis/tendonitis of shoulder

  Contraindication: CABG surgery, history of asthma, uricaria or allergic reactions to aspirin or other NSAIDs

  Black Box: serious CV thrombotic events, MI, stroke, GI bleeding, Ulceration and stomach or intestine perforation

  Beer's: Yes

  Counseling for drug class: withhold for at least 4-6 halflives prior to surgical/dental procedures, with food, use lowest dose or shortest duration of time

  Counseling for drug: max dose is 400mg/day
• Ciclodan

  
  

  Generic: ciclopirox

  Class: topical antifungal agent

  Indication: dermatologic conditions

  Contraindication: N/A

  Black Box: N/A

  Beer's: no

  Counseling for drug class: topical use only, avoid contact with eyes and mouth, blisters, burning, itchy redness, don't start or stop without checking with doctor

  Counseling for drug: may change hair or nail color, don't use with nail polish , protect from light, heat, or open flame
• Banzel

  
  

  Generic: rufinamide

  Class: antiseizure agent, triazole derivative

  Indication: Lennox-Gastaut syndrome

  Contraindication: familial short QT syndrome

  Black Box: N/A

  Beer's: no

  Counseling for drug class: caution about performing tasks that require mental alertness, don't discontinue abruptly

  Counseling for drug: with food, monitor signs of suicide ideation, discard oral suspension within 90 days of opening
• Antabuse

  
  

  Generic: disulfiram

  Class: aldehyde dehydrogenase inhibitor

  Indication: moderate-severe alcohol use disorder

  Contraindication: alcohol use, metronidazole, paradehyde or alcohol-containing preparations, psychosis, severe myocardial disease or coronary occlusion

  Black Box: alcohol intoxication

  Beer's: no

  Counseling for drug class: monitor hepatotoxicity, caution in patients with diabetes

  Counseling for drug: avoid alcohol for at least 12 hours before take dose, disulfiram reactions can occur up to 14 days after finish if alcohol is consumed, monitor liver function
• Arava

  
  

  Generic: leflunomide

  Class: disease modifying antirheumatic

  Indication: rheumatoid arthritis

  Contraindication: severe hepatic impairment, concomitant treatment with teroflunomide, pregnancy

  Black Box: embyrofetal toxicity, hepatotoxicity

  Beer's: No

  Counseling for drug class: monitor signs of infections, hazardous agent, can cause fatigue and pale skin

  Counseling for drug: mild-moderate diarrhea, protect from light, vaccinations of live vaccines not recommended
• Xultophy

  
  

  Generic: insulin degludec, liraglutide

  Class: GLP-1 receptor agonist, long-acting insulin, antidiabetic agent

  Indication: T2DM

  Contraindication: history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, during episodes of hypoglycemia

  Black Box: thyroid c-cell tumor risk

  Beer's: no

  Counseling for drug class: SQ use, store unopened pens in fridge, not approved for diabetic ketoacidosis or T1DM

  Counseling for drug: don't mix with other insulin, once injected continue to press until dial reached 0 then another 6sec, use used pens within 21 days
• iDose TR, Travatan Z

  
  

  Generic: travaprost

  Class: antiglaucoma opthalmic agent, ophthalmic prostaglandin

  Indication: ocular hypertension or open angle glaucoma

  Contraindication: ocular implant, active or suspected ocular or periocular infection, corneal endothelial cell dystrophy

  Black Box: N/A

  Beer's: no

  Counseling for drug class: monitor intraocular pressure, remove contacts before administration and wait 15min after to put pack

  Counseling for drug: use in evening, keep eyes closed and put pressure in inside corner of eye for 1-2min, if using more than 1 drug in same eye wait 5 min