Endocrinology
• denosumab (Prolia®) – injectable
– Class: Monoclonial antibody
– Use: postmenopausal women who have
osteoporosis where other therapies have
failed and who have increased risk of
fractures
– MOA: Increases bone resorption, leading to
increase bone mass and strength of bone
Excellence in Care
New Medications Released in 2011/2002
Featuring
Elizabeth Huss, RN BSN
And
Dr. Richard Espinosa, R.Ph
Endocrinology
• denosumab (Prolia®) – injectable
– Side effects: osteonecrosis of the jaw
– Unique Characteristics: Patients need to
have adequate calcium intake to minimize
– Advise patients to seek prompt medical
attention if they develop signs or symptoms
of hypocalcemia (paresthesias or muscle
stiffness, twitching, spasms, or cramps),
infections (including cellulitis), or
dermatological reactions.
Endocrinology
• denosumab (Prolia®) – injectable
– Dose: 60mg subcutaneously q 6 months
minimizing esophagus and stomach
irritation problem
Endocrinology
• liraglutide (Victoza®) – once-a-day
injectable independent of meals
– Class: Glucagon-like peptide 1 receptor
agonist
– Use: Type 2 diabetes
Endocrinology
• liraglutide (Victoza®) – once-a-day
injectable independent of meals
– MOA: increase insulin release in the
presence of elevated glucose
concentrations; also decreases glucagon
secretion in a glucose-dependent manner.
The mechanism of blood glucose lowering
also involves a delay in gastric emptying.
Endocrinology
• liraglutide (Victoza®) – once-a-day
injectable independent of meals
– Side effects: decreased hypoglycemia,
gastroparesis leads to delayed absorption of
co-administered medications
– Unique Characteristics:
• Not a substitute for insulin in insulin
requiring patients.
• Helps with weight loss
Oncology
• fentanyl (Abstral®) – sublingual tablets
– Class: Narcotic Analgesic
– Use: for breakthrough cancer pain for
patients who are already on opioid
medications.
– MOA: decreases the awareness of pain
– Side effects: constipation, dizziness, and
drowsiness
– Unique Characteristics: it is administered
under the tongue for quick relief.
Oncology
• pedinterferon alfa-2b (Sylatron®) – sub Q
injectable
– Class: Immunodulator
– Use: treatment of malignant melanoma
from coming back after it has been
removed by surgery.
– MOA: made from human proteins that help
the body fight viral infections.
Oncology
• pedinterferon alfa-2b (Sylatron®) – sub Q
injectable
– Side effects: fatigue
– Unique Characteristics:
• You should take 500 mg to 1,000 mg of
acetaminophen 30 minutes before your
first dose of Sylatron to reduce flu-like
symptoms
• May lead to depression
Oncology
• vandetanib (Caprelsa®; Vandetanib®) –
tablet
– Class: anti-cancer agent (kinase inhibitor)
– Use: treatment of symptomatic or
progressive thyroid cancer in patients with
unresectable locally advanced or metastatic
disease.
– MOA: inhibits tumor growth and metastasis
– Side effects: arrhythmias; sudden death
Oncology
• vandetanib (Caprelsa®; Vandetanib®) –
tablet
– Unique Characteristics:
• If tablets cannot be taken whole, the
tablets can be dispersed in a glass
containing 2 ounces of non-carbonated
water and stirred for approximately 10
minutes until the tablet is dispersed (will
not completely dissolve).
• Can cause fetal harm
Oncology
• cabazitaxel (Jevtana®) – injectable q 3
weeks
– Class: Taxoid
– Use: combination with prednisone for the
treatment of patients with hormonerefractory metastatic prostate cancer
– MOA: Inhibits mitosis by disrupting
cancerous cells not to divide.
Oncology
• cabazitaxel (Jevtana®) – injectable q 3
weeks
– Side effects: diarrhea, nausea, leukopenia
and anemia
– Unique Characteristics: Explain the
importance of routine CBCs due to
decreased WBC.
Neurology/Psychiatry
• trazodone (Oleptro®) – scored ex-tended
release tablet
– Class: anti-depressant; serotonin modulator
– Use: Major Depressive Disorder – adults
– MOA: Increases serotonin activity in the
brain
Neurology/Psychiatry
• trazodone (Oleptro®) – scored ex-tended
release tablet
– Side effects: postural hypotension,
constipation, drowsiness
– Unique Characteristics:
• It should be taken once-a-day with light
meal or snack
• Priapism
Neurology/Psychiatry
• gabapentin enacarbil (Horizant®) –
extended release tablet
– Class: anticonvulsant/analgesic
– Use: Moderate to Severe Restless leg
Syndrome
– MOA: blocks selected calcium channels
Neurology/Psychiatry
• gabapentin enacarbil (Horizant®) –
extended release tablet
– Side effects: sedation and dizziness
– Unique Characteristics:
• This product is not interchangeable with
other gabapentin products.
• Swallow whole; 1 tab daily taken with
food at 5pm
Neurology/Psychiatry
• gabapentin (Gralise®) – once daily tablet
– Class: anti-convulsant/analgesic
– Use: Treatment of Post-Herpetic Neuralgia
(PHN)
– MOA: unknown, but decreases pain related
responses
Neurology/Psychiatry
• gabapentin (Gralise®) – once daily tablet
– Side effects: somnolence, dizziness
– Unique Characteristics:
• Once-a-day dosing with minimal side
effects
• If discontinuing it should be done
gradually over one week
Neurology/Psychiatry
• vilazodone hydrochloride (Viibyrd®) –
tablets
– Class: Selective serotonin reuptake inhibitor
and Serotonin Receptor Agonist
– Use: Major Depressive Disorder
– MOA: Increases Serotonin activity. It is also
a partial agonist at serotonergic 5-HT 1A
receptors.
Neurology/Psychiatry
• vilazodone hydrochloride (Viibyrd®) –
tablets
– Side effects: diarrhea
– Unique Characteristics:
• Take with food & discontinue slowing
• Does not interfere with sexual desire
Neurology/Psychiatry
• hydromorphone (Exalgo®) – extended
release tablet
– Class: opioid narcotic analgesic
– Use: chronic pain that last around the clock
– MOA: works by binding to opioid receptors
in the brain to reduce pain.
Neurology/Psychiatry
• hydromorphone (Exalgo®) – extended
release tablet
– Side effects: constipation, dizziness,
drowsiness, & respiratory depression
– Unique Characteristics:
• swallow tablet whole with lots of water,
& no alcohol drinking
• Not used in patients who have pain once
in a while.
Neurology/Psychiatry
• ketorlac (Sprix®) – nasal spray
– Class: Non-steroidal anti-inflammatory
– Use: short term up to 5 days moderate to
moderately severe pain relief at the opioid
level
– MOA: decreases the inflammatory process
by decreasing prostaglandin synthesis.
Neurology/Psychiatry
• ketorlac (Sprix®) – nasal spray
– Side effects: GI irritation(ulcers) and
increase in bleeding
– Unique Characteristics:
• convenient, potent, and rapid-acting;
Sprix® nasal spray should be discarded
within 24 hours of taking the first dose,
even if the bottle still contains some
medication.
• Provides lowering of morphine dose with
use of Sprix®
Anti-Inflammatory
• ibuprofen and famotidine (Duexis®) coated
tablet
– Class: NSAID and H-2 Antagonist
– Use: Rheumatoid Arthritis and osteoarthritis
– MOA: decreases inflammation and decreases
HCL production
– Side effects: Ibuprofen: may cause new
hypertension, or may elevate BP if
hypertensive, may increase risk of thrombotic
events, MI, or stroke.
– Unique Characteristics: decreases ulcer risk
formation.
Anti-inflammatory
• tocilizumab (Actemra®) – injectable
– Class: immunomodulator
– Use: Adult and Juvenile arthritis; 2 years
and up
– MOA: interleukin 6 inhibits IL-6 receptor
that signals for R.A. signs and symptoms
Anti-inflammatory
• tocilizumab (Actemra®) – injectable
– Side effects: neutropenia, low platelet
counts, elevated liver enzyme
– Unique Characteristics:
• Injection every 4 weeks
• Decreases immune system
• Increases GI-irritation
Respiratory
• roflumilast (Daliresp®) – tablet
– Class: Phosphodiesterase 4 inhibitor
– Use: Treatment of COPD
– MOA: Selectively inhibits
phosphodiesterase 4 (PDE4), decreasing
inflammation in the lungs
– Side effects: weight loss, UTI, dizziness
– Unique Characteristics: once-a-day dosing;
this is not a bronchodilator
Cardiovascular
• azilsartan medoxomil (Edarbi®) – once-aday tablet
– Class: Angiotensin II receptor antagonist
– Use: hypertension
– MOA: Blocks the vasoconstrictor and
aldosterone-secreting effects of angiotensin
II by selectively blocking the binding of
angiotensin II to the AT 1 receptor in many
tissues, such as vascular smooth muscle and
the adrenal gland.
Cardiovascular
• azilsartan medoxomil (Edarbi®) – once-aday tablet
– Side effects: rarely cough; hypotension
– Unique Characteristics: Careful using
NSAIDs with this drug to minimize renal
function failure; pregnancy category C in
the 1st trimester, catergory D in the 2nd and
3rd trimester
Removed from Market
• acetaminophen and propoxyphene
(Darvocet N-100®), Nov. 2010
– Class: Narcotic Analgesic
– Use: Pain
– Reason for removal:
• propoxyphene puts patients at risk of
potentially serious or even fatal heart
rhythm abnormalities.
• the FDA concluded that the risks of the
medication outweigh the benefits.