Pediatrics Review

Common Antidotes

Common Antidotes

Drug	Antidotes
Acetaminophen	acetylcysteine
Alcohol	thiamine
Anticholinesterase (insecticides)	atropine, pralidoxime
Anticholinergics	physostigmine
Benzodiazepine	flumazenil
Beta blockers	calcium chloride, epinephrine, glucagon
Calcium blockers	calcium chloride, glucagon
Carbon monoxide	hyperbaric, oxygen
Cyclophosphamide	mesna
Cyanide	amyl nitrate, sodium nitrate, sodium thiosulfate
Digoxin	digoxin immune fab
Dopamine	phenotolamine
Extrapyrimidal symptoms	diphenhydramine
Ethylene glycol	fomepizole, ethanol
Heroin	naloxone, nalmefene
Heparin	protamine sulfate
Iron	deferoxamine
Lead	dimercapol, edetate calcium, disodium
Methemoglobinemia	methylene blue
Methotrexate	leucovorin
Neuromuscular blockade	anticholinesterase
Potassium	albuterol inhaler, insulin/glucose, NaHCO3, kayexalate
Serotonin syndrome	cyproheptadine
Sulfonylurea hypoglycemic	octreotide
Theophylline	pyridoxine
Warfarin	phytonadione, vitamin K

Weight Loss and Gain Medications

Weight Loss Medications

Use with reduced-calorie diet and increased physical activity

Contrave (naltrexone/bupropion)

·         Naltrexone is an opiod antagonist

·         BMI

o   30 kg/m² or greater (obese) or

o   27 kg/m² or greater (overweight) + comorbidity

§  Hypertension

§  Type 2 diabetes mellitus

§  Dyslipidemia

·         4-week dose titration schedule

·         ADR – suicidality, neuropsychiatric reactions

·         Administration

o   NOT cut, chew, or crush Contrave tablets

o   NOT take Contrave with high-fat meals à seizures

Belviq (lorcaserin)

·         Serotonin 2C receptor agonist

·         ADR - serotonin syndrome, neuroleptic malignant syndrome

·         Administration

o   with or without food

Qsymia (phentermine/topiramate)

·         Phentermine - sympathomimetic amine anorectic

·         Topiramate - antiepileptic medication

·         ADR - concentration, memory, and speech difficulties

·         Administration

o   With or without food

o   Avoid in evening à insomnia

o   Avoid alcohol à dizziness and sleepiness

o   NOT stop suddenly à seizures

Alli (orlistat)

·         Inhibits gastrointestinal lipases

·         Administration

o   3 times a day with each main meal containing fat

o   Take multivitamin with A,D,E,K

·         ADR – GI effects, gas

Evaluate response after 12 weeks

If 5% weight loss not seen à stop drug

Weight Loss Bariatric Surgery

• BMI > 35 + comorbidity (hypertension, dyslipidemia, type 2 diabtes)
• BMI > 40

Weight Gain Medications

• Anticonvulsants (carbamazepine, gabapentin, pregabalin, valproic acid, lithium)
• Antidepressants (phenelzine, mirtazapine, paroxetine, amitriptyline, nortriptyline)
• Antihistamines (H1 blockers - cetirizine)
• Antihypertensives (atenolol, propanolol)
• Vasodilators (minoxidil)
• Antipsychotics (chlorpromazine, clozapine, iloperidone, olanzapine, quetiapine, risperidone)
• Corticosteroids 
• Hormonals (medroxyprogesterone, megestrol)
• Hypoglycemic (insulin, sulfonylureas, meglitinides, thiazolidinediones)

Source:

http://www.pharmacytimes.com/contributor/anyssa-garza/2015/03/weight-loss-medications-on-the-market

Addyi (filbanserin) Drug Information

·         Background

o   HSDD 7.7 to 14% of premenopausal women in the US or 5.5 to 8.6 million individuals

o   developed by Sprout pharmaceuticals

o   approved by FDA on June 4, 2015

·         Indication

o   hypoactive sexual desire disorder (HSDD)

·         Adverse effects

o   fainting, nausea, dizziness, sleepiness, low blood pressure

·         Mechanism

o   mechanism is unknown

o   mixed agonist/antagonist effect on postsynaptic serotonergic receptors

o   5HT1A agonist and 5HT2A antagonist

·         Concerns

o   avoid with alcohol due to concerns about central nervous system depression, hypotension, syncope

o   avoid in pregnant women

o   avoid with strong or moderate CYP3A4 inhibitors

o   prior to HSDD, it was considered for antidepressant indication and though all antidepressants have a black box warning for suicides, there is no sign of increase risk with filbanserin

·         Pharmacokinetics

o   peak levels reached in 45 to 60 minutes of administration

o   peak levels are delayed by 1 to 3 hours with meal

o   terminal elimination half-life is 12 hours

o   taking with high fat high calorie meal increases exposure 50%

o   administration with CYP3A4 inhibitors (ketoconazole, fluconazole) increases filbanserin 4.5 and 7 times, respectively

o   hormonal contraceptives are weak inhibitors of CYP3A4, but increase filbanserin 40%

Source:
Pharmacy Times. What to Know About “Female Viagra” Backed by FDA Panel.  http://www.pharmacytimes.com/news/what-to-know-about-female-viagra-backed-by-fda-panel#sthash.UW4UXYXR.dpuf

Drug Information Question

Question: Patient asked whether her Metformin interacted with an over-the-counter medication she was taking. 

Answer: Based on researching the information in Micromedex, it was found that there was no interaction of concern. To further understand possible over-the-counter medications interactions with Metformin, I read the journal article Drug Interactions of Medications Commonly Used in Diabetes and learned that the major OTC interaction of metformin is cimetidine.  Cimetidine causes a 60% increase in peak metformin plasma levels. The incidence of metformin-induced lactic acidosis may reach 0.084 cases per 1000 patient-years, with 50% of the cases being fatal.  Other adverse effects associated with metformin are upset stomach, B12 deficiency, and headache.

Source:

Metformin.  Drug Interactions.  Micromedex Solutions.  Truven Health Analytics, Inc. Greenwood Village, CO.  Available at: http://www.micromedexsolutions.com.  Accessed May 22, 2015.

Triplitt, C. "Drug Interactions of Medications Commonly Used in Diabetes." Diabetes Spectrum (2006):19(4); 202-11.