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Top 200 - Counseling Points

Jon Warta Wed May 09 15:41:53 CDT 2012

Hydrocodone and acetaminophen


Avoid alcohol - CNS depression, hepatotoxicity
Do not exceed recommended dosing
Dependence
Overdose = fatal respiratory depression
Use caution with mental alertness tasks
Major ADRs: CNS effects, GI upset, constipation (only one that doesn't diminish over time)

-statins
Can take with or w/o food, and anytime, but better at night because of cholesterol synthesis
Lipitor is meant to work along with diet and exercise (not a replacement)
Avoid excess alcohol
Usually 2/day for men, 1/day for women
Report any abnormal muscle pain, cramping, or weakness or brown urine (rhabdomyolysis)
Report yellowing of the skin or eyes (liver damage)

Levothyroxine
Take on empty stomach 0.5-1 hours before breakfast with a full glass of water (Levoxyl tabs can swell and disintegrate
rapidly making them difficult swallow)
Need to continue therapy with levothyroxine for life to control hypothyroidism
If you become pregnant, contact doctor, may need to increase dose
Counsel patient on hypo/hyperthyroidism and tell them to let you know if they experience any of the symptoms

-prils
Take 1st dose at bedtime (help with the possible hypotension)
Main ADRs: diarrhea, HA, dizziness
Careful standing up quickly
Let your doctor or pharmacist know if you develop dry unproductive cough
Let your doctor or pharmacist know if you become pregnant or plan to become pregnant
Avoid salt substitutes that contain potassium
Contact your doctor or pharmacist if signs of swelling, especially in the face, or if welts develop (sign of angioedema)

Amoxicillin
If GI upset, take with food/drink
Take entire prescription (even if you feel better)
Talk to your doctor if worse/no improvement
Can decrease the effectiveness of birth control - use back up form of contraceptive to be safe

Esomeprazole
Take 1 hour before breakfast each day
Swallow capsules whole
Contents of capsules can be mixed in applesauce (1 tablespoon) - dont chew or warm the mixture
Main ADRs: HA, GI upset, dry mouth
Report any persistent side effects

Antacids can be taken at the same time

Clopidogrel
Main ADRs: HA, dizziness, N/V/C
May take longer than usual to stop bleeding - seek medical help if bleeding will not stop
Report abnormal chest pain, SOB, or rash

Escitalopram
Do not stop taking med or change dose without talking to doctor or pharmacist
Avoid caffeine and alcohol
Caution with tasks requiring mental alertness until response to medication is known
Inform prescriber if you become or plan to become pregnant

Montelukast
Take every evening (even if you feel better)
It can take several weeks to see an effect
Do not use for a current asthma attack (SABA)
Don't mix with anything but: applesauce, carrots, rice, ice cream, baby formula, or breast milk. Take within 15 min of
opening
Major ADRs: HA (can take APAP, ASA, or Ibuprofen), fatigue, dizziness
Report any neuropsychiatric changes (suicide)
Tell Dr. or pharmacist if you plan to become pregnant

Metoprolol
DO NOT stop w/o talking to Dr/pharmacist
Can cause cardiovascular complications (rebound) < very important
Continue to take even if you feel better
Careful standing up quickly, especially at first
Not a replacement for diet and exercise and should be used along with these lifestyle changes
Avoid alcohol (sedation and dizziness)
If diabetic, BBs can mask s/s of hypoglycemia (except sweating)

Albuterol
Prime before first use and if it hasnt been used for 2 weeks (4 test sprays into air)
Exhale, then inhale deeply while actuating the inhaler
Hold breath for ~10 seconds
Wait one minute between inhalations
Always keep inhaler with you get refill before you run out
If you have more than one inhaled medication, use albuterol first; it will open your lungs so the other medication is
more effective
Discard canister after taking doses
Only take as much as prescribed

Amlodipine
Can be taken with or w/o food
Take every day even if you feel fine
Not a replacement for diet and exercise
Major ADRs: HA, GI upset, fatigue
Report any persistent side effects
Tell your doctor or pharmacist if you experience abrupt weight gain (3-5 lbs/week). Could be a sign of edema

Avoid excess alcohol

Azithromycin
Take it all even if you feel better
If GI upset, take with food
Report severe or persistent GI upset
If taking the suspension: Shake well before each dose

Metformin
Main ADRs: diarrhea
Take with meals to decrease side effects
Do not crush or chew tablets
Part of ER tab may be excreted in stool
Avoid excess alcohol
Metformin is not a replacement for diet/exercise (both still every important in the management of diabetes)
Go over s/s of both hypoglycemia and what to do if hypoglycemia occurs

HCTZ
Take in morning to avoid nocturnal diuresis
Careful standing up quickly (OH)
Can cause photosensitivity (wear sunscreen and avoid prolonged direct sunlight)
Not a replacement for diet/exercise
If patient has diebetes, monitor glucose closely (especially during initiation of HCTZ)
Report any persistent side effects

Furosemide
Take in a.m. with food to decrease GI upset
Careful standing up quickly (OH)
Keep medication in original container
Needs to be protected from light
Do not take if discolored
May cause photosensitivity - use sunscreen and avoid prolonged sunlight
Keep track of your weight - report any significant weight gain or loss
If patient has diabetes: Monitor glucose closely (especially during initiation of therapy)

Warfarin
Check ALL medication changes/additions
Do not stop taking w/o consultation
Make sure patient knows color
Take at the same time each day, w or w/o food
Make every INR appointment
Keep vitamin K and alcohol intake consistent
Vitamin K is mainly found in green leafy vegetables such as broccoli, spinach, etc)
Don't cut yourself

Advair Diskus
Take 2 puffs bid even if feel better
Advair = long-term control of asthma or COPD
Can take up to a month to see full benefits
Exhale completely (NOT into the diskus) and put lips around mouthpiece

Inhale quickly and forcefully


Hold breath for 10 secs, 1 min between puffs
Wash mouth out after using (prevent thrush)
Let you doctor or pharmacist know if advair doesnt seem to work as well as it used to or seems to make you condition
worse

Sertraline
Keep taking even if you feel better
May take 3 months to see the full effects
Do not stop taking or change dose w/o consult
Avoid alcohol entirely while on sertraline
Main ADRs: GI upset, possible sexual dysfunction, dry mouth, sweating
If it causes insomnia, take in the morning
Report any persistent side effects

-sartans
Consult if pregnant or plan to become pregnant
Main ADRs: HA, dizziness
Careful standing up quickly (OH)
Avoid salt substitutes that contain potassium
Avoid excess alcohol
Keep taking even if you feel better
Not a replacement for diet and exercise, both very important in controlling HTN

Zolpidem
Do not chew or crush Ambien CR
Edluar should be placed under the tongue and allowed to dissolve
Take all doses right before bed
Avoid alcohol while on Zolpidem
Can be habit forming

Oxycodone and acetaminophen


Avoid alcohol: hepatotoxicity, CNS depression
Do not exceed dosing: dependence
Overdose can = fatal respiratory depression
Use caution performing tasks that need mental alertness (CNS effects)
Major ADRs: CNS depression, dysphoria/euphoria, GI upset
Most all side effects will diminish over time except constipation

Duloxetine
Swallow pill whole (do not crush or chew)
Do not stop w/o consultations
Can take up to a month to see full effects
Main ADRs: GI upset, somnolence or insomnia, HA, decreased appetite, dry mouth
Use caution when performing tasks requiring mental alertness especially initially
Monitor glucose closely in diabetics

Quetiapine
Dont change your dose without consultation
Main side effects: somnolence, constipation, dry mouth, dizziness

Careful standing up quickly (OH)


Use caution preforming activities requiring mental alertness
Contact your physician if you have any severe or persistent side effects

Venlafaxine
Do not stop w/o consultation
Take with food
Swallow caps or tabs whole (do not crush)
Avoid alcohol (additive CNS depression)
Main ADRs: HA, insomnia or somnolence, dry mouth, sweating, possible sexual side effects, weight loss

Tamsulosin
Swallow capsules whole (dont crush or chew)
Take at the same time each day: about 30 minutes after a meal
Main ADRs: HA, dizziness, abnormal ejaculation, OH, and rhinitis

Alprazolam
Avoid alcohol entirely
Take ER tablets in the morning
Use caution performing tasks that require mental alertness especially initially
Do not stop or change dose w/o consultation

Valsartan with HCTZ


Inform doctor or pharmacist of pregnancy
Take in the a.m. to avoid nocturnal diuresis
Main ADRs: hypotension, dizziness, and diarrhea
Careful standing up quickly (OH)

Trazodone
Take right after food
If taking for insomnia, take before bed
If taking for depression, may take several weeks to see the effects
Dont stop w/o consultation
Avoid alcohol: additive CNS depression
Main ADRs: HA, sedation, nausea, dry mouth, blurred vision
If prolonged erection, stop and contact doctor
Inform doctor or pharmacist about pregnancy

Pioglitazone
Use alcohol with caution (risks hypoglycemia
Go over and have patient report any signs/symptoms of heart failure: edema, weight gain, shortness of breath
Go over signs/symptoms or hypoglycemia and counsel on how to handle hypoglycemia if it occurs

Alendronate
Take 1st thing in the a.m. with glass of water
Remain upright for at least 30 min after taking
Don't take other oral meds within 30 min
If a dose is missed, then the missed dose can be taken the next day (> day = wait and take the next dose)
Main ADRs: GI upset, headache

Sulfamethoxazole and trimethoprim


Take on empty stomach, 1 hour before or 2 hours after a meal, with a full glass of water
If using oral suspension, shake well before use
Take it all even if you feel better
Avoid prolonged exposure to sunlight
Main ADRs: GI upset, dizziness, decreased appetite

Lansoprazole
Take qd dosing first thing in the morning on empty stomach (0.5-1 hour before breakfast)
Not for heartburn self-care for over 2 weeks
If unable to swallow caps, mix in with ~1 tablespoon of applesauce or ~60 mL of orange or apple juice
Take the mixture immediately and do not chew or crush the granules
Place tablets on tongue and allow to dissolve

Clonazepam
Avoid alcohol: additive CNS depression
Use caution performing tasks that require mental alertness, especially initially
Do not stop or change frequency without talking with your doctor or pharmacist first

Tramadol
Swallow ER tabs whole (do not crush or chew)
Do not overdose
Avoid alcohol: additive CNS depression
Main ADRs: HA, flushing, somnolence/insomnia, GI upset
Take with food if GI upset
CNS depression
Perform tasks requiring mental alertness with caution

Levofloxacin
Take it all even if you feel better
Oral solution should be taken on an empty stomach (1 hour before or 2 hours after a meal)
Main ADRs: GI upset, HA, insomnia
Photosensitivity
Monitor glucose closely in diabetics

Fluoxetine
May take 3 months to see full effects
Keep taking fluoxetine even if you feel better
Avoid ADRs: HA, drowsiness, GI upset)
Decreased libido may also occur

Prednisone
Take with food to decrease GI upset
Also avoid alcohol to decrease GI upset
Diabetics: monitor blood glucose closely
Main ADRs: HA, insomnia, edema

Insulin products
Take each dose at the same time every day
Keep track of your blood glucose
Go over s/s of hypoglycemia and what to do if hypoglycemia is experienced

Omeprazole
Take qd first thing in the morning on empty stomach (30 min to an hour before breakfast)
Avoid alcohol (adds to GI irritation)
Not recommended to self-treat for GERD or heartburn for more that 2 weeks
Tablets or capsules be swallowed whole (do not crush or chew)
If caps cannot be swallowed, the contents can be mixed with ~1 tablespoon of applesauce
Main ADRs: possible GI upset and HA

Fenofibrate
Not a replacement for diet and exercise should be used along with these lifestyle changes
Take with food to increase absorption
Main ADRs: HA, GI upset
Report any unexplained muscle pain or weakness to doctor or pharmacist

Celecoxib
Take with food to reduce GI upset
Other common side effect is headache
Talk with your doctor or pharmacist before taking other NSAIDs

Donepezil
Doesn't cure Alzheimers disease, but may slow its progression and reduce symptoms
Take each dose at night before bed
If taking the ODTs, allow to dissolve, then follow with a glass of water
Main ADRs: GI upset, insomnia, HA
GI upset should subside within 3 wk; be patient

Ezetimibe with simvastatin


Take each dose in the evening
Meant to work along with diet and exercise
Avoid excess alcohol
Recommended limits = 2/day men, 1 for women
Main ADRs: HA and GI upset
Inform provider about pregnancy
Report any abnormal muscle pain, cramping, or weakness or brown urine (rhabdomyolysis)
Report yellowing of the skin or eyes

Cephalexin
Take it all (even if you feel better)
Main ADRs: GI upset, headache, dizziness)
Take with food if GI upset is an issue
Contact doctor if condition worsens or does not improve upon completing the prescription
Can decrease the effectiveness of birth control
Use back up form of contraception to be safe

Mometasone
Shake then pump bottle ~10 times until mist
Shake bottle well and blow nose before use
Tilt head forward, insert applicator into nostril
Close the other nostril
Spray Nasonex into the nostril and inhale through your nose, then out through your mouth
Clean the tip and replace the cap after use
Each bottle should be discarded after 120 (usually 30 days) even if some left
Main side effects: HA, cough, nose bleed

Contraceptives
Use backup contraception 1st 7 days
Go over what to do for missed doses (kinda long)
Smoking increases risk of ADRs
Main side effects: GI upset, altered menstrual flow, breast tenderness, weight gain, HA
Stop if you have any ACHES side effects

Ezetimibe
Take Zetia at the same time every day
If missed by 8 hours, skip that dose and return to normal dosing schedule upon next dose
Not a replacement for diet and exercise and is meant to work with these lifestyle modifications to help lower your
cholesterol
Common side effects: diarrhea and fatigue

Gabapentin
Gabapentin can cause CNS depression, so use caution performing mental alertness tasks
Avoid alcohol (additive CNS depression)
Do not stop taking gabapentin without talking with your doctor or pharmacist first, especially important if you're taking it
for seizures
Main ADRs: drowsiness, dizziness, GI upset
Report any persistent or severe side effects

Pregabalin
Do not stop w/o consultation
Common side effects: (weight gain, dry mouth blurred vision)
Report unexplained muscle pain or weakness
Caution with mental alertness tasks
Avoid alcohol (additive CNS depression)

Sildenafil
Inform provider of other meds before starting
Avoid grapefruit juice
Dont combine Viagra with other ED treatments w/o talking to provider
Common side effects: HA, dyspepsia, flushing, and insomnia
Erection longer than 4 hours bad
Notify provider of any hearing/vision loss

Tylenol with codeine


Avoid alcohol (CNS depression, hepatotoxicity)

Do not exceed recommended dosing


Caution with mental alertness tasks
Major ADRs: CNS Effects (CNS depression, euphoria or dysphoria), GI upset
Take each dose with food if nausea is an issue
Side effects diminish, except constipation

Fluconazole
Take it all even if you feel better
Shake suspensions before each dose
Common side effects: HA, GI upset
Report these severe side effects: Yellowing of the skin or eyes, Irregular heart beat, Rash

Fluticasone
Can work in days, but maybe weeks
Shake well and blow nose before use
If you haven't used if for over a week, depress 6 times until a fine spray comes out first
Insert tip into one nostril, close other
Breathe in through nose while pressing pump
Main side effects: HA, dizziness, nasal irritation

Losartan
Inform provider of pregnancy plans
Main side effects: diarrhea, fatigue, c & c
Careful standing up quickly (OH)
Avoid salt substitutes that contain potassium
Avoid excess alcohol
Keep taking Cozaar even if you feel better
Not a replacement for diet and exercise

Valacyclovir
Does not cure genital herpes
Does not prevent transmission to others
Start taking it at the first sign of herpes onset
Stay well hydrated while taking Valtrex
Common side effects: HA, GI upset

Lorazepam
Avoid alcohol while taking lorazepam
Can be habit forming - don't exceed dose
Side effects: drowsiness, dizziness, weakness
Caution with mental alertness tasks, especially initially

Pantoprazole
Take each dose at the same time each day (preferably in the morning)
Swallow tablets whole (no split, chew, crush)
Avoid alcohol (GI irritation)
Can take antacids along with for instant relief
Main side effects: GI upset, HA

Amlodipine with benazepril


Inform provider of pregnancy
Do not stop w/o consultation
Avoid salt substitutes that contain potassium
Careful standing up quickly, especially initially
Common side effects: HA, GI upset
Let your doctor know about: dry unproductive cough, or swelling/welts, especially in the face

Conjugated estrogens
Take at bedtime to decrease side effects
Continue to get annual gynecological exams and perform self-breast exams at least monthly
Common side effects: HA, breast, abdominal, or back pain, abnormal menstrual bleeding
Report A.C.H.E.S. ADRs

Oseltamivir
Not a replacement for the flu shot
Does not decrease transmission to others
Take it all even if you feel better
The main side effect is GI upset, usually subsides after 2 days of treatment
Take with food if GI upset is an issue
Report hallucinations or abnormal confusion

Spiriva Handihaler
Take at the same time everyday
Not for current bronchospasm; do not swallow
Exhale fully,p lace lips around mouthpiece, inhale slowly and deeply
Hold breath as long as possible (5-10 secs min)
Repeat inhalation at least once until no powder remains in capsule, discard capsule
The most common side effect is dry mouth

Aripiprazole
Avoid alcohol (additive CNS depression)
Caution with mental alertness tasks, especially initially
Use oral solution within 6 months of opening bottle
Common side effects: HA, agitation, GI upset, and weight gain

Pravastatin
Not a replacement diet and exercise
Avoid excess alcohol: recommended daily limits = 2/day for men and 1/day for women
Common side effects: HA, fatigue, and GI upset
Report any abnormal muscle pain, cramping, or weakness or brown urine (rhabdomyolysis)
Report yellowing of the skin or eyes (liver damage)

Methylphenidate
Don't stop or change dose w/o consultation
Take with water, milk, or juice; with or w/o food
Avoid alcohol and caffeine
Can decrease appetite
Concerta tablet shell can show up in stool

Report: tachycardia, chest pain, nervousness, insomnia, tremors, skin rash, black stool

Digoxin
Do not stop without consultation
Check your pulse at the same time each day and let your doctor know of any changes
Maintain adequate potassium intake
Common side effects: GI upset, HA, bradycardia
Report any swelling, palpitations, persistent diarrhea, or visual disturbances

Fexofenadine
Do not take any more often than every 12 hours
Side effects are mild, but you may experience headache or a little drowsiness
Report any severe or persistent side effects

Triamterene with HCTZ


Take each dose in the morning (because of increased diuresis)
Avoid excess sunlight (photosensitivity)
Careful standing up quickly (OH)
Main side effects: fatigue, muscle cramps, GI
Take with food if GI upset is an issue

Methylprednisolone
Don't stop taking without consultation
Side effects: HA, GI upset, sleep disturbance
Take with food if GI upset is an issue

Cyclobenzaprine
Can impair physical and mental abilities
Caution with mental alertness tasks
Avoid alcohol while taking (additive effects)
Side effects: drowsiness, dizziness, dry mouth

Clonidine
Don't stop without consultation
Abrupt discontinuation --> rebound HTN
The transdermal patch as well as its location should be changed every week
Side effects: dry mouth, drowsiness, HA, dizziness

Risedronate
Swallow the tablets whole
Take in a.m. with water 30 min before eating
Remain upright for 30 min after taking
Don't take any other oral meds within 30 min
Miss daily dose? Skip that day
Miss weekly dose? You have 1 day to make it up
Miss monthly dose? Can take up to 7 days after

Diazepam
Avoid alcohol
Can be habit-forming; dont exceed dose
Don't stop without consultation (withdrawal)
Side effects: drowsiness, uncoordination, fatigue
Caution with mental alertness tasks, especially initially

Carisoprodol
Can cause drowsiness and dizziness
Caution with mental alertness tasks
Avoid alcohol (additive drowsiness)
Side effects: HA, GI upset
Take each with food if GI upset is an issue

Promethazine
If taking for motion sickness, first dose should be taken 30 min to 1 hour before departure
Side effects: drowsiness, dizziness, dry mouth, GI upset
Take with food to avoid GI upset

Memantine
Take with or without food
Common side effects: dizziness, headache, GI upset

K-Dur
Take each dose with a full glass of water
Avoid salt substitutes that contain potassium
Common side effect is GI upset
Report any severe or persistent side effects including: Unexplained muscle weakness, leg cramps, irregular heat beat

Citalopram
May take 3 months to see full effects
Keep taking even if you feel better
Avoid alcohol while on citalopram
Main side effects: GI upset, sleep disturbances, dry mouth, sexual dysfunction (reversible)

Meloxicam
Take with food or milk to decrease GI upset
Avoid use of aspirin and other NSAIDs (such as naproxen or ibuprofen)
Main side effects are GI in nature (n/v/d)

Latanoprost
Remove contacts and wait 15 min after administration before reinserting
Common side effects include blurred vision, burning, stinging, or itching of the eyes, and increased pigmentation of the
iris

Carvedilol

Take every day even if you feel better


Abruptly stopping can cause serious CV effects
Check pulse daily; watch for abnormal lows
Monitor glucose carefully in diabetics
Common side effects : Hypotension, diarrhea, muscle weakness, and weight gain
Careful standing up quickly (OH)

Oxycontin
Avoid alcohol (CNS, respiratory depression)
Don't exceed dose (fatal respiratory depression)
Use caution performing tasks requiring mental or physical alertness, especially with initial therapy

Allopurinol
Take each dose after meals and with a full glass of water
Main side effect is GI upset

Tolterodine
Take each dose with food
Swallow whole (don't break, crush, chew)
Common side effects include dry mouth, headache/dizziness, and abdominal pain
Use caution performing tasks requiring mental or physical alertness
Report any difficulty or pain urinating

Penicillin VK
Take it all
Take each dose on an empty stomach (1 hour before or 2 hours after meals)
Most common side effect is GI upset (N/V/D)
Take with small meals if this is an issue

Klor-Con
Swallow long-acting dosage forms whole
May dissolve powder form in water
Liquid form can be diluted in water, juice
Most common side effect is GI upset
Taking each dose with food should help
Let your doctor know if you experience any unexplained muscle weakness or cardiac arrhythmias

Codeine with guaifenesin


Cheratussin AC causes CNS depression
Caution with mental or physical alertness
Avoid alcohol (CNS depression)
Take with glass of water (will help thin the mucous, make it easier to expel)
Common side effects: drowsiness, HA, GI upset
Take with food if GI upset is an issue

Glyburide
Take the qd dose with first main meal of day
If bid, separate the doses by 12 hours

Keep track of your blood glucose


Side effects: hypoglycemia, weight gain
Go over s/s of hypoglycemia and what to do if hypoglycemia is experienced

Lisdexamfetamine
Take every morning
Psychological and physical dependence can occur (especially with prolonged use)
Avoid excess alcohol (CNS depression)
Common side effects include headache, decreased appetite, insomnia, and dry mouth

Isosorbide mononitrate
Take IR tablets bid about 7 hrs apart (8am, 3pm)
Take the ER tablets in the morning
No PDE5-Is while on nitrates
Careful standing up quickly (OH)
Side effects: HA, flushing, GI upset, and cough

Lamotrigine
Tablets should be swallowed whole and taken every day, even if you feel better
Do not stop taking lamotrigine without talking with your doctor or pharmacist
Doing so could cause or increase seizures
Side effects: GI upset, sleep disturbances, weight loss, dry mouth, rash, and fatigue

Olanzapine
It may take up to a month to see full results
Avoid alcohol and alertness tasks
Inform provider of any medication changes
ADRs: tiredness, HA, dizziness, dry mouth, constipation, muscle weakness, weight gain
Report these serious ADRs: cardiac abnormalities, muscle rigidity or tremor, severe feeling of distress or restlessness

NuvaRing
No hormonal contraceptives for a month before
Insert ring on 1st day of menstrual cycle
Can also be done on day 2-5 (1st day preferred)
Use backup contraceptive for the first week
If switching from an oral combo contraceptive, insert ring within a week of last active tablet; no backup contraceptive is
needed
Can be stored at room temperature for 4 months

Buproprion
Take everyday ud even if you feel better
Avoid alcohol (CNS depression)
Inform provider of medication changes
Tablet shell in stool is normal
Common side effects: HA/dizziness, insomnia, dry mouth, weight loss, and nausea

Doxycycline
Take until gone
Take with food to reduce GI upset

To reduce throat irritation, take with a full glass of water and don't lay down right after
Side effects: joint pain, menstrual pain, and photosensitivity (avoid prolonged sunlight)
Avoid alcohol and stay well hydrated

Ibandronate
Take 1st thing in the a.m. with a glass of water
Remain upright for at least 60 min after taking
Do not take any other med within 60 minutes
Patients should avoid alcohol (osteoporosis contributor)
Main side effects: GI upset, dyspepsia, headache, insomnia, and back pain

Combivent
If it's been more than a day, prime by shaking for ~10 seconds, spray 3 times into the air
First breath out deeply through mouth
Now breathe slowly and deeply through device
Hold breath for 10 secs then breathe out slowly
Wait about 2 minutes in between puffs
Discard after 200 actuations; report palpitations

Meclizine
Mmay impair physical and mental abilities (especially if taken with sedatives or alcohol), so use with caution until you
see how you will respond to the medication
Common side effects include drowsiness and thickening or bronchial secretions
Let you doctor or pharmacist know if meclizine does not relief motion sickness or vertigo symptoms

Buprenorphine and naloxone


Suboxone will decrease effects of other opioids
Patients should avoid other opioids, alcohol
Main side effects: HA, vomiting, sweating, possible hypotension/low blood pressure
Caution with physical or mental alertness tasks, as Suboxone can cause CNS depression
Report jaundice, dark brown urine, sharp stabbing pain in right upper abdomen

Raloxifene
Only for postmenopausal women, dosing is qd
Common side effects include edema/welling, hot flashes, and muscle cramps/spams
Avoid prolonged periods of restricted movement (due to risk of DVT, PE)
Inform doctor or pharmacist immediately if you experience any ACHES symptoms