Gabapentin (Neurontin): Drug class, mechanism of action, indications, and abuse/misuse considerations?

Class: Gabapentinoid / Anticonvulsant. Mechanism: Binds the alpha-2-delta auxiliary subunit of voltage-gated calcium channels in the CNS, decreasing excitatory neurotransmitter release (does NOT bind GABA receptors). Indications: Postherpetic neuralgia, focal onset seizures, neuropathic pain. Misuse: Sedation, euphoria; controlled substance in multiple states.

Alprazolam (Xanax, Xanax XR): Drug class, mechanism of action, indications, and withdrawal risk?

Class: Short-to-intermediate acting Benzodiazepine (Schedule IV). Mechanism: Allosteric modulator of GABA-A receptor, increasing frequency of chloride channel opening. Indications: Panic disorder, generalized anxiety. Risk: High abuse liability and rapid tolerance; abrupt discontinuation triggers severe rebound anxiety, tremors, hallucinations, and life-threatening withdrawal seizures.

Omeprazole (Prilosec): Drug class, mechanism of action, optimal administration timing, and long-term adverse risks?

Class: Proton Pump Inhibitor (PPI). Mechanism: Irreversibly binds and inhibits the H+/K+ ATPase pump in gastric parietal cells, blocking the final step of gastric acid secretion. Timing: Take 30 to 60 minutes before first meal of the day. Long-term risks: Hypomagnesemia, vitamin B12 deficiency, Clostridioides difficile-associated diarrhea, osteoporotic bone fractures.

Trazodone (Desyrel): Drug class, mechanism, low-dose indication, and rare urological emergency?

Class: Serotonin Antagonist and Reuptake Inhibitor (SARI). Mechanism: Antagonizes 5-HT2A receptors and inhibits 5-HT reuptake; potent H1 and alpha-1 antagonist. Low-dose indication: Insomnia (50–100 mg at bedtime). Rare emergency: Priapism (prolonged, painful penile erection > 4 hours requiring emergent intracavernosal phenylephrine or surgical aspiration).

Famotidine (Pepcid): Drug class, mechanism of action, clinical indications, and dose adjustment?

Class: Histamine-2 (H2) Receptor Antagonist. Mechanism: Competitive inhibitor of H2 receptors on gastric parietal cells, suppressing basal and nocturnal gastric acid secretion. Indications: GERD, peptic ulcer disease, heartburn prophylaxis. Dose adjustment: Requires dose or frequency reduction in moderate-to-severe renal impairment (CrCl < 50 mL/min) to avoid CNS confusion/somnolence.

Citalopram (Celexa): Drug class, mechanism, and specific FDA warning regarding cardiac electrophysiology?

Class: SSRI (racemic mixture of R and S enantiomers). Warning: Causes dose-dependent QT interval prolongation and Torsades de Pointes. Maximum recommended dose is 40 mg/day in adults, and maximum 20 mg/day in clients > 60 years old, CYP2C19 poor metabolizers, or those on CYP2C19 inhibitors (e.g., cimetidine).

Tramadol (Ultram): Drug class, dual mechanism of action, Schedule status, and critical toxicity risks?

Class: Centrally acting analgesic (Schedule IV). Dual mechanism: Weak mu-opioid receptor agonist and inhibitor of norepinephrine and serotonin reuptake. Risks: Lowers seizure threshold (risk of grand mal seizures, especially when combined with antidepressants or antipsychotics); causes Serotonin Syndrome when combined with serotonergic drugs; subject to CYP2D6 metabolism.

Oxycodone / Acetaminophen (Percocet): Schedule class, mechanism, prescribing precautions, and patient counseling?

Class: Schedule II Opioid combination. Mechanism: Oxycodone is a pure mu-opioid receptor agonist; APAP provides non-opioid peripheral analgesia. Precautions: Strict accounting of total daily acetaminophen from all sources (maximum 3,000–4,000 mg/day) to prevent hepatotoxicity. Counseling: High addiction risk, respiratory depression, constipation (co-prescribe stimulant laxative), avoid alcohol.

Albuterol (ProAir HFA, Ventolin HFA, Proventil HFA): Drug class, receptor mechanism, indications, and adverse effects?

Class: Short-Acting Beta-2 Agonist (SABA). Mechanism: Stimulates beta-2 adrenergic receptors in bronchial smooth muscle, activating adenylate cyclase, increasing cAMP, and causing rapid bronchodilation (onset 5–15 min). Indication: Acute relief of bronchospasm in asthma/COPD and exercise-induced bronchospasm. Adverse effects: Tachycardia, skeletal muscle tremor, palpitations, hypokalemia.

Sertraline (Zoloft): Drug class, mechanism of action, indications, and FDA Boxed Warning?

Class: Selective Serotonin Reuptake Inhibitor (SSRI). Mechanism: Selectively inhibits neuronal reuptake of serotonin (5-HT), increasing synaptic serotonin. Indications: MDD, OCD, Panic Disorder, PTSD, Social Anxiety, PMDD. Boxed Warning: Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults (<= 24 years). Adverse effects: Diarrhea/nausea, sexual dysfunction, insomnia.

Fluoxetine (Prozac, Sarafem): Drug class, pharmacokinetic half-life, and required washout before MAOIs?

Class: SSRI. Pharmacokinetics: Exceptionally long half-life (parent drug 2–4 days, active metabolite norfluoxetine 7–16 days). Clinical significance: Self-tapering effect with minimal discontinuation syndrome. Washout period: Must wait at least 5 weeks after stopping fluoxetine before initiating an MAOI to avoid fatal Serotonin Syndrome (standard washout for other SSRIs is 2 weeks).

Escitalopram (Lexapro): Drug class, stereochemistry, mechanism, and maximum recommended dosing?

Class: SSRI. Stereochemistry: Pure active S-enantiomer of citalopram; highly selective for serotonin transporter. Maximum dose: 20 mg/day (10 mg/day in elderly > 65 years or hepatic impairment due to dose-dependent QT interval prolongation).

Diazepam (Valium): Drug class, active metabolites, clinical indications, and lipophilicity?

Class: Long-acting Benzodiazepine (Schedule IV). Lipophilicity: Highly lipophilic with rapid brain penetration but extensive tissue redistribution; active metabolites (desmethyldiazepam, oxazepam) produce prolonged sedation (half-life > 100 hours). Indications: Acute anxiety, muscle spasm/spasticity, acute alcohol withdrawal delirium, seizures.

Montelukast (Singulair): Drug class, mechanism of action, administration timing, and FDA Boxed Warning?

Class: Leukotriene Receptor Antagonist (LTRA). Mechanism: Competitively blocks the cysteinyl leukotriene 1 (CysLT1) receptor, inhibiting airway edema, smooth muscle contraction, and inflammation. Timing: Administered once daily in the evening for asthma. Boxed Warning: Serious Neuropsychiatric events (agitation, aggression, depression, sleep disturbances, suicidal ideation and behavior).

Fluticasone Propionate (Flovent HFA, Flonase): Drug class, mechanism of action, and essential post-inhalation instruction?

Class: Inhaled / Intranasal Corticosteroid (ICS). Mechanism: Potent anti-inflammatory that inhibits multiple inflammatory cytokines and inflammatory cell migration. Indication: Maintenance therapy of asthma and allergic rhinitis. Instruction: Client MUST rinse mouth thoroughly with water and spit it out after every oral inhalation to prevent Oral Candidiasis (thrush) and dysphonia.

Venlafaxine (Effexor XR): Drug class, concentration-dependent receptor pharmacology, and vital sign monitoring?

Class: SNRI. Pharmacology: At low doses ( = 150–225 mg/day), significantly inhibits norepinephrine reuptake. Vital sign: Blood pressure must be monitored regularly because norepinephrine reuptake inhibition causes dose-dependent sustained diastolic hypertension.

Levothyroxine (Synthroid, Levoxyl): Drug class, hormonal pharmacology, half-life, and proper oral administration?

Class: Synthetic thyroid hormone (T4). Pharmacology: Converted to active triiodothyronine (T3) in peripheral tissues. Half-life: ~7 days (requires 4–6 weeks to reach steady state before rechecking TSH). Administration: Take first thing in the morning with a full glass of water, on an empty stomach, at least 30 to 60 minutes before food or coffee; separate from calcium, iron, or antacids by 4 hours.

Mirtazapine (Remeron): Drug class, receptor antagonism mechanisms, and dual side effects beneficial in frail elderly?

Class: Noradrenergic and Specific Serotonergic Antidepressant (NaSSA). Mechanism: Central presynaptic Alpha-2 adrenergic antagonist (increases NE and 5-HT release), plus 5-HT2, 5-HT3, and H1 receptor antagonist. Beneficial side effects: Prominent sedation and appetite stimulation with weight gain (prescribed at bedtime for insomnia and anorexia in depressed elderly or oncology patients).

Clonazepam (Klonopin): Drug class, elimination half-life, indications, and combined opioid warning?

Class: Long-acting Benzodiazepine (Schedule IV; half-life 30–40 hours). Indications: Panic disorder, seizure disorders (absence, myoclonic, Lennox-Gastaut). Combined warning: FDA Boxed Warning that concomitant use of benzodiazepines and opioids results in profound sedation, fatal respiratory depression, coma, and death.

Pregabalin (Lyrica): Drug class, Schedule classification, mechanism, and advantages over gabapentin?

Class: Gabapentinoid (Schedule V controlled substance). Mechanism: High-affinity binding to alpha-2-delta calcium channel subunit. Indications: Diabetic peripheral neuropathy, fibromyalgia, spinal cord injury pain, postherpetic neuralgia. Advantages: Predictable linear pharmacokinetics with > 90% oral bioavailability independent of dose (unlike saturable gabapentin absorption), and faster onset of relief.

Tamsulosin (Flomax) vs Finasteride (Proscar): Compare drug classes, mechanisms, clinical onset, and ophthalmic/teratogenic risks in BPH:

Tamsulosin: Selective Alpha-1A adrenergic blocker; relaxes bladder neck and prostatic smooth muscle; onset is days; carries risk of Intraoperative Floppy Iris Syndrome (IFIS) during cataract surgery. Finasteride: 5-Alpha Reductase inhibitor; blocks testosterone to dihydrotestosterone (DHT) conversion, shrinking prostate size; onset requires 3–6 months; pregnant women must NOT handle crushed tablets (teratogenic to male fetus).

Pantoprazole (Protonix): Drug class, dosage forms, and specific advantage in clients receiving Clopidogrel (Plavix)?

Class: Proton Pump Inhibitor (PPI). Dosage forms: Oral delayed-release tablets and Intravenous (IV) for severe upper GI bleeding. Advantage: Displays the weakest inhibition of CYP2C19 among all PPIs; therefore, it does not significantly interfere with the bioactivation of the antiplatelet prodrug Clopidogrel (making it the preferred PPI with Plavix).

Ondansetron (Zofran, Zuplenz): Drug class, mechanism of action, indications, and electrophysiological risk?

Class: 5-HT3 (Serotonin) Receptor Antagonist. Mechanism: Selectively blocks 5-HT3 receptors centrally in the chemoreceptor trigger zone (CTZ) and peripherally on vagal nerve terminals in the GI tract. Indications: Chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting. Electrophysiological risk: Dose-dependent QT interval prolongation (caution in long QT syndrome).

Lorazepam (Ativan): Drug class, route options, status epilepticus role, and metabolism in liver disease ('LOT')?

Class: Intermediate-acting Benzodiazepine (Schedule IV; PO, IM, IV). Role: First-line IV medication for terminating Status Epilepticus (4 mg IV slow push). Liver disease: Metabolized purely by direct glucuronidation without active metabolites; along with Oxazepam and Temazepam ('LOT' mnemonic), it is safe to use in liver impairment and elderly patients.

Allopurinol (Zyloprim): Drug class, mechanism of action, clinical use, and pharmacogenomic screening?

Class: Xanthine Oxidase Inhibitor. Mechanism: Inhibits xanthine oxidase, blocking the sequential conversion of hypoxanthine to xanthine, and xanthine to uric acid. Use: First-line urate-lowering therapy for chronic gout prophylaxis. Pharmacogenomics: Screen for HLA-B*5801 allele prior to initiation in patients of Southeast Asian (Han Chinese, Korean, Thai) or African descent; positive allele carries extreme risk of Stevens-Johnson syndrome.

Meloxicam (Mobic): Drug class, COX selectivity, indications, and Boxed Warnings?

Class: Nonsteroidal Anti-inflammatory Drug (NSAID; oxicam class). Mechanism: Preferential inhibitor of Cyclooxygenase-2 (COX-2) over COX-1, reducing prostaglandin synthesis. Indications: Osteoarthritis and Rheumatoid Arthritis. Boxed Warnings: Increased risk of serious cardiovascular thrombotic events (MI and stroke) and life-threatening gastrointestinal bleeding, ulceration, and perforation.

Celecoxib (Celebrex): Drug class, mechanism of action, GI advantage, and chemical contraindication?

Class: Selective Cyclooxygenase-2 (COX-2) inhibitor NSAID. Mechanism: Selectively inhibits COX-2 without inhibiting COX-1 at therapeutic doses, leaving gastric mucosal prostaglandin protection and platelet thromboxane production unaffected. Advantage: Lower risk of symptomatic GI ulcers compared to non-selective NSAIDs. Contraindication: Known sulfonamide hypersensitivity ('sulfa allergy').

Bupropion (Wellbutrin XL/SR, Zyban): Drug class, mechanism, unique clinical advantages, and absolute contraindications?

Class: Norepinephrine-Dopamine Reuptake Inhibitor (NDRI). Advantages: No sexual dysfunction and causes mild weight loss (useful for MDD, seasonal affective disorder, and smoking cessation). Contraindications: Seizure disorders, bulimia or anorexia nervosa (high risk of grand mal seizures), and abrupt discontinuation of alcohol or sedatives.

Hydrocodone / Acetaminophen (Norco, Vicodin, Lortab): Schedule class, indications, and overdose reversal?

Class: Schedule II Opioid analgesic combination (reclassified from C-III to C-II in 2014). Indications: Moderate-to-severe acute pain. Overdose reversal: Naloxone (Narcan) immediately reverses mu-receptor respiratory depression; IV N-Acetylcysteine (NAC) reverses toxic acetaminophen overdose if ingestion occurred.

Duloxetine (Cymbalta): Drug class, dual mechanism, FDA indications beyond depression, and hepatotoxicity?

Class: Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Dual mechanism: Inhibits reuptake of both 5-HT and NE. Indications: MDD, GAD, Diabetic Peripheral Neuropathic Pain, Fibromyalgia, Chronic Musculoskeletal Pain (osteoarthritis/lower back). Warning: Avoid in hepatic insufficiency or chronic heavy alcohol consumption due to rare severe hepatotoxicity.

Tiotropium (Spiriva HandiHaler, Spiriva Respimat): Drug class, mechanism of action, indications, and patient device instruction?

Class: Long-Acting Muscarinic Antagonist (LAMA). Mechanism: Reversibly blocks M3 muscarinic receptors in bronchial smooth muscle, preventing acetylcholine-mediated bronchoconstriction. Indications: COPD maintenance and severe persistent asthma. Instruction for HandiHaler: The dry powder capsule must NEVER be swallowed orally; it must be punctured and inhaled through the HandiHaler device.

Zolpidem (Ambien, Ambien CR, Intermezzo): Drug class, mechanism of action, Schedule class, and Boxed Warning?

Class: Non-benzodiazepine hypnotic ('Z-drug'). Mechanism: Selectively binds GABA-A alpha-1 subunit, facilitating GABA-mediated inhibitory neurotransmission. Controlled status: Schedule IV. Boxed Warning: Complex sleep behaviors (sleepwalking, sleep-driving, preparing food, making phone calls while not fully awake, with complete amnesia), which can cause serious injury or death.

Top 200 Drugs (NAPLEX & Pharmacy) — CNS, Psychiatric, Analgesic, Respiratory, GI & Endocrine Brand/Generic/MOA

High-frequency Top 200 drugs across neurological, psychiatric, pain, pulmonary, gastroenterology, and endocrine domains: Brand/Generic pairs, neurotransmitter mechanisms, side-effect profiles, and critical warnings.

Level: basic
Languages: en → en
Cards: 32
Markdown: Top 200 Drugs (NAPLEX & Pharmacy) — CNS, Psychiatric, Analgesic, Respiratory, GI & Endocrine Brand/Generic/MOA (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	Gabapentin (Neurontin): Drug class, mechanism of action, indications, and abuse/misuse considerations?	Class: Gabapentinoid / Anticonvulsant. Mechanism: Binds the alpha-2-delta auxiliary subunit of voltage-gated calcium channels in the CNS, decreasing excitatory neurotransmitter release (does NOT bind GABA receptors). Indications: Postherpetic neuralgia, focal onset seizures, neuropathic pain. Misuse: Sedation, euphoria; controlled substance in multiple states.
2	Alprazolam (Xanax, Xanax XR): Drug class, mechanism of action, indications, and withdrawal risk?	Class: Short-to-intermediate acting Benzodiazepine (Schedule IV). Mechanism: Allosteric modulator of GABA-A receptor, increasing frequency of chloride channel opening. Indications: Panic disorder, generalized anxiety. Risk: High abuse liability and rapid tolerance; abrupt discontinuation triggers severe rebound anxiety, tremors, hallucinations, and life-threatening withdrawal seizures.
3	Omeprazole (Prilosec): Drug class, mechanism of action, optimal administration timing, and long-term adverse risks?	Class: Proton Pump Inhibitor (PPI). Mechanism: Irreversibly binds and inhibits the H+/K+ ATPase pump in gastric parietal cells, blocking the final step of gastric acid secretion. Timing: Take 30 to 60 minutes before first meal of the day. Long-term risks: Hypomagnesemia, vitamin B12 deficiency, Clostridioides difficile-associated diarrhea, osteoporotic bone fractures.
4	Trazodone (Desyrel): Drug class, mechanism, low-dose indication, and rare urological emergency?	Class: Serotonin Antagonist and Reuptake Inhibitor (SARI). Mechanism: Antagonizes 5-HT2A receptors and inhibits 5-HT reuptake; potent H1 and alpha-1 antagonist. Low-dose indication: Insomnia (50–100 mg at bedtime). Rare emergency: Priapism (prolonged, painful penile erection > 4 hours requiring emergent intracavernosal phenylephrine or surgical aspiration).
5	Famotidine (Pepcid): Drug class, mechanism of action, clinical indications, and dose adjustment?	Class: Histamine-2 (H2) Receptor Antagonist. Mechanism: Competitive inhibitor of H2 receptors on gastric parietal cells, suppressing basal and nocturnal gastric acid secretion. Indications: GERD, peptic ulcer disease, heartburn prophylaxis. Dose adjustment: Requires dose or frequency reduction in moderate-to-severe renal impairment (CrCl < 50 mL/min) to avoid CNS confusion/somnolence.
6	Citalopram (Celexa): Drug class, mechanism, and specific FDA warning regarding cardiac electrophysiology?	Class: SSRI (racemic mixture of R and S enantiomers). Warning: Causes dose-dependent QT interval prolongation and Torsades de Pointes. Maximum recommended dose is 40 mg/day in adults, and maximum 20 mg/day in clients > 60 years old, CYP2C19 poor metabolizers, or those on CYP2C19 inhibitors (e.g., cimetidine).
7	Tramadol (Ultram): Drug class, dual mechanism of action, Schedule status, and critical toxicity risks?	Class: Centrally acting analgesic (Schedule IV). Dual mechanism: Weak mu-opioid receptor agonist and inhibitor of norepinephrine and serotonin reuptake. Risks: Lowers seizure threshold (risk of grand mal seizures, especially when combined with antidepressants or antipsychotics); causes Serotonin Syndrome when combined with serotonergic drugs; subject to CYP2D6 metabolism.
8	Oxycodone / Acetaminophen (Percocet): Schedule class, mechanism, prescribing precautions, and patient counseling?	Class: Schedule II Opioid combination. Mechanism: Oxycodone is a pure mu-opioid receptor agonist; APAP provides non-opioid peripheral analgesia. Precautions: Strict accounting of total daily acetaminophen from all sources (maximum 3,000–4,000 mg/day) to prevent hepatotoxicity. Counseling: High addiction risk, respiratory depression, constipation (co-prescribe stimulant laxative), avoid alcohol.
9	Albuterol (ProAir HFA, Ventolin HFA, Proventil HFA): Drug class, receptor mechanism, indications, and adverse effects?	Class: Short-Acting Beta-2 Agonist (SABA). Mechanism: Stimulates beta-2 adrenergic receptors in bronchial smooth muscle, activating adenylate cyclase, increasing cAMP, and causing rapid bronchodilation (onset 5–15 min). Indication: Acute relief of bronchospasm in asthma/COPD and exercise-induced bronchospasm. Adverse effects: Tachycardia, skeletal muscle tremor, palpitations, hypokalemia.
10	Sertraline (Zoloft): Drug class, mechanism of action, indications, and FDA Boxed Warning?	Class: Selective Serotonin Reuptake Inhibitor (SSRI). Mechanism: Selectively inhibits neuronal reuptake of serotonin (5-HT), increasing synaptic serotonin. Indications: MDD, OCD, Panic Disorder, PTSD, Social Anxiety, PMDD. Boxed Warning: Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults (<= 24 years). Adverse effects: Diarrhea/nausea, sexual dysfunction, insomnia.
11	Fluoxetine (Prozac, Sarafem): Drug class, pharmacokinetic half-life, and required washout before MAOIs?	Class: SSRI. Pharmacokinetics: Exceptionally long half-life (parent drug 2–4 days, active metabolite norfluoxetine 7–16 days). Clinical significance: Self-tapering effect with minimal discontinuation syndrome. Washout period: Must wait at least 5 weeks after stopping fluoxetine before initiating an MAOI to avoid fatal Serotonin Syndrome (standard washout for other SSRIs is 2 weeks).
12	Escitalopram (Lexapro): Drug class, stereochemistry, mechanism, and maximum recommended dosing?	Class: SSRI. Stereochemistry: Pure active S-enantiomer of citalopram; highly selective for serotonin transporter. Maximum dose: 20 mg/day (10 mg/day in elderly > 65 years or hepatic impairment due to dose-dependent QT interval prolongation).
13	Diazepam (Valium): Drug class, active metabolites, clinical indications, and lipophilicity?	Class: Long-acting Benzodiazepine (Schedule IV). Lipophilicity: Highly lipophilic with rapid brain penetration but extensive tissue redistribution; active metabolites (desmethyldiazepam, oxazepam) produce prolonged sedation (half-life > 100 hours). Indications: Acute anxiety, muscle spasm/spasticity, acute alcohol withdrawal delirium, seizures.
14	Montelukast (Singulair): Drug class, mechanism of action, administration timing, and FDA Boxed Warning?	Class: Leukotriene Receptor Antagonist (LTRA). Mechanism: Competitively blocks the cysteinyl leukotriene 1 (CysLT1) receptor, inhibiting airway edema, smooth muscle contraction, and inflammation. Timing: Administered once daily in the evening for asthma. Boxed Warning: Serious Neuropsychiatric events (agitation, aggression, depression, sleep disturbances, suicidal ideation and behavior).
15	Fluticasone Propionate (Flovent HFA, Flonase): Drug class, mechanism of action, and essential post-inhalation instruction?	Class: Inhaled / Intranasal Corticosteroid (ICS). Mechanism: Potent anti-inflammatory that inhibits multiple inflammatory cytokines and inflammatory cell migration. Indication: Maintenance therapy of asthma and allergic rhinitis. Instruction: Client MUST rinse mouth thoroughly with water and spit it out after every oral inhalation to prevent Oral Candidiasis (thrush) and dysphonia.
16	Venlafaxine (Effexor XR): Drug class, concentration-dependent receptor pharmacology, and vital sign monitoring?	Class: SNRI. Pharmacology: At low doses (< 150 mg/day), predominantly inhibits serotonin reuptake; at higher doses (>= 150–225 mg/day), significantly inhibits norepinephrine reuptake. Vital sign: Blood pressure must be monitored regularly because norepinephrine reuptake inhibition causes dose-dependent sustained diastolic hypertension.
17	Levothyroxine (Synthroid, Levoxyl): Drug class, hormonal pharmacology, half-life, and proper oral administration?	Class: Synthetic thyroid hormone (T4). Pharmacology: Converted to active triiodothyronine (T3) in peripheral tissues. Half-life: ~7 days (requires 4–6 weeks to reach steady state before rechecking TSH). Administration: Take first thing in the morning with a full glass of water, on an empty stomach, at least 30 to 60 minutes before food or coffee; separate from calcium, iron, or antacids by 4 hours.
18	Mirtazapine (Remeron): Drug class, receptor antagonism mechanisms, and dual side effects beneficial in frail elderly?	Class: Noradrenergic and Specific Serotonergic Antidepressant (NaSSA). Mechanism: Central presynaptic Alpha-2 adrenergic antagonist (increases NE and 5-HT release), plus 5-HT2, 5-HT3, and H1 receptor antagonist. Beneficial side effects: Prominent sedation and appetite stimulation with weight gain (prescribed at bedtime for insomnia and anorexia in depressed elderly or oncology patients).
19	Clonazepam (Klonopin): Drug class, elimination half-life, indications, and combined opioid warning?	Class: Long-acting Benzodiazepine (Schedule IV; half-life 30–40 hours). Indications: Panic disorder, seizure disorders (absence, myoclonic, Lennox-Gastaut). Combined warning: FDA Boxed Warning that concomitant use of benzodiazepines and opioids results in profound sedation, fatal respiratory depression, coma, and death.
20	Pregabalin (Lyrica): Drug class, Schedule classification, mechanism, and advantages over gabapentin?	Class: Gabapentinoid (Schedule V controlled substance). Mechanism: High-affinity binding to alpha-2-delta calcium channel subunit. Indications: Diabetic peripheral neuropathy, fibromyalgia, spinal cord injury pain, postherpetic neuralgia. Advantages: Predictable linear pharmacokinetics with > 90% oral bioavailability independent of dose (unlike saturable gabapentin absorption), and faster onset of relief.
21	Tamsulosin (Flomax) vs Finasteride (Proscar): Compare drug classes, mechanisms, clinical onset, and ophthalmic/teratogenic risks in BPH:	Tamsulosin: Selective Alpha-1A adrenergic blocker; relaxes bladder neck and prostatic smooth muscle; onset is days; carries risk of Intraoperative Floppy Iris Syndrome (IFIS) during cataract surgery. Finasteride: 5-Alpha Reductase inhibitor; blocks testosterone to dihydrotestosterone (DHT) conversion, shrinking prostate size; onset requires 3–6 months; pregnant women must NOT handle crushed tablets (teratogenic to male fetus).
22	Pantoprazole (Protonix): Drug class, dosage forms, and specific advantage in clients receiving Clopidogrel (Plavix)?	Class: Proton Pump Inhibitor (PPI). Dosage forms: Oral delayed-release tablets and Intravenous (IV) for severe upper GI bleeding. Advantage: Displays the weakest inhibition of CYP2C19 among all PPIs; therefore, it does not significantly interfere with the bioactivation of the antiplatelet prodrug Clopidogrel (making it the preferred PPI with Plavix).
23	Ondansetron (Zofran, Zuplenz): Drug class, mechanism of action, indications, and electrophysiological risk?	Class: 5-HT3 (Serotonin) Receptor Antagonist. Mechanism: Selectively blocks 5-HT3 receptors centrally in the chemoreceptor trigger zone (CTZ) and peripherally on vagal nerve terminals in the GI tract. Indications: Chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting. Electrophysiological risk: Dose-dependent QT interval prolongation (caution in long QT syndrome).
24	Lorazepam (Ativan): Drug class, route options, status epilepticus role, and metabolism in liver disease ('LOT')?	Class: Intermediate-acting Benzodiazepine (Schedule IV; PO, IM, IV). Role: First-line IV medication for terminating Status Epilepticus (4 mg IV slow push). Liver disease: Metabolized purely by direct glucuronidation without active metabolites; along with Oxazepam and Temazepam ('LOT' mnemonic), it is safe to use in liver impairment and elderly patients.
25	Allopurinol (Zyloprim): Drug class, mechanism of action, clinical use, and pharmacogenomic screening?	Class: Xanthine Oxidase Inhibitor. Mechanism: Inhibits xanthine oxidase, blocking the sequential conversion of hypoxanthine to xanthine, and xanthine to uric acid. Use: First-line urate-lowering therapy for chronic gout prophylaxis. Pharmacogenomics: Screen for HLA-B*5801 allele prior to initiation in patients of Southeast Asian (Han Chinese, Korean, Thai) or African descent; positive allele carries extreme risk of Stevens-Johnson syndrome.
26	Meloxicam (Mobic): Drug class, COX selectivity, indications, and Boxed Warnings?	Class: Nonsteroidal Anti-inflammatory Drug (NSAID; oxicam class). Mechanism: Preferential inhibitor of Cyclooxygenase-2 (COX-2) over COX-1, reducing prostaglandin synthesis. Indications: Osteoarthritis and Rheumatoid Arthritis. Boxed Warnings: Increased risk of serious cardiovascular thrombotic events (MI and stroke) and life-threatening gastrointestinal bleeding, ulceration, and perforation.
27	Celecoxib (Celebrex): Drug class, mechanism of action, GI advantage, and chemical contraindication?	Class: Selective Cyclooxygenase-2 (COX-2) inhibitor NSAID. Mechanism: Selectively inhibits COX-2 without inhibiting COX-1 at therapeutic doses, leaving gastric mucosal prostaglandin protection and platelet thromboxane production unaffected. Advantage: Lower risk of symptomatic GI ulcers compared to non-selective NSAIDs. Contraindication: Known sulfonamide hypersensitivity ('sulfa allergy').
28	Bupropion (Wellbutrin XL/SR, Zyban): Drug class, mechanism, unique clinical advantages, and absolute contraindications?	Class: Norepinephrine-Dopamine Reuptake Inhibitor (NDRI). Advantages: No sexual dysfunction and causes mild weight loss (useful for MDD, seasonal affective disorder, and smoking cessation). Contraindications: Seizure disorders, bulimia or anorexia nervosa (high risk of grand mal seizures), and abrupt discontinuation of alcohol or sedatives.
29	Hydrocodone / Acetaminophen (Norco, Vicodin, Lortab): Schedule class, indications, and overdose reversal?	Class: Schedule II Opioid analgesic combination (reclassified from C-III to C-II in 2014). Indications: Moderate-to-severe acute pain. Overdose reversal: Naloxone (Narcan) immediately reverses mu-receptor respiratory depression; IV N-Acetylcysteine (NAC) reverses toxic acetaminophen overdose if ingestion occurred.
30	Duloxetine (Cymbalta): Drug class, dual mechanism, FDA indications beyond depression, and hepatotoxicity?	Class: Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Dual mechanism: Inhibits reuptake of both 5-HT and NE. Indications: MDD, GAD, Diabetic Peripheral Neuropathic Pain, Fibromyalgia, Chronic Musculoskeletal Pain (osteoarthritis/lower back). Warning: Avoid in hepatic insufficiency or chronic heavy alcohol consumption due to rare severe hepatotoxicity.
31	Tiotropium (Spiriva HandiHaler, Spiriva Respimat): Drug class, mechanism of action, indications, and patient device instruction?	Class: Long-Acting Muscarinic Antagonist (LAMA). Mechanism: Reversibly blocks M3 muscarinic receptors in bronchial smooth muscle, preventing acetylcholine-mediated bronchoconstriction. Indications: COPD maintenance and severe persistent asthma. Instruction for HandiHaler: The dry powder capsule must NEVER be swallowed orally; it must be punctured and inhaled through the HandiHaler device.
32	Zolpidem (Ambien, Ambien CR, Intermezzo): Drug class, mechanism of action, Schedule class, and Boxed Warning?	Class: Non-benzodiazepine hypnotic ('Z-drug'). Mechanism: Selectively binds GABA-A alpha-1 subunit, facilitating GABA-mediated inhibitory neurotransmission. Controlled status: Schedule IV. Boxed Warning: Complex sleep behaviors (sleepwalking, sleep-driving, preparing food, making phone calls while not fully awake, with complete amnesia), which can cause serious injury or death.