Corticosteriods

Nutrients Depleted: Calcium, Folic Acid, Magnesium, Potassium, Selenium, Vitamin C, Vitamin D, Zinc

U.S. Brand Names:Acticort 100®; Adlone® Injection; AeroBid®-M Oral Aerosol Inhaler; AeroBid® Oral Aerosol Inhaler; Aeroseb-Dex®; Aeroseb-HC® A-hydroCort®; AK-Dex®; AK-Pred® Ophthalmic; Ala-Cort®; Ala-Scalp®; Alba-Dex®; Alphatrex®; Amcort®; A-methaPred® Injection; Anucort-HC® Suppository; Anuprep HC® Suppository; Anusol® HC-1 [OTC]; Anusol® HC-2.5% [OTC]; Anusol-HC® Suppository; Aristocort®; Aristocort® A; Aristocort® Forte; Aristocort® Intralesional; Aristospan® Intra-Articular; Aristospan® Intralesional; Articulose-50® Injection; Atolone®; Azmacort™; Baldex®; Betratrex®; Beta-Val®; CaldeCORT®; CaldeCORT® Anti-Itch Spray; Celestone®; Celestone® Soluspan®; Cel-U-Jec®, Cetacort®; Clocort® Maximum Strength; CotraGel® [OTC]; Cortaid® Maximum Strength [OTC]; Cortaid® with Aloe [OTC]; Cort-Dome®; Cortef®; Cortef Feminine Itch; Cortenema®; Cortifoam®; Cortizone®-5 [OTC]; Cortizone®-10 [OTC]; Cortone® Acetate; Cultivate™; Dalalone L.A.®; Decaderm®; Decadron®; Decadron® LA; Decadron® Turbinaire®; Decaject-LA®; Decaspray®; Dekasol-LA®; Delcort®; Delta-Cortef® Oral; Deltasone®; Delta-Tritex®; depMedalone® Injection; Depoject® Injection; Depo-Medrol® Injection; Depropred® Injection; Dermacort®; Dermarest Dricort®; DermiCort®; Dermolate® [OTC]; Dermtex® HC with Aloe; Dexair®; Dexasone LA®; Dexone®; Dexone LA®; Dezone®; Diprolene®; Diprolene® AF; Diprosone®; D-Med® Injection; Duralone® Injection; Econopred® Ophthalmic; Econopred® Plus Ophthalmic; Eldecort®; Elocon® Topical; Flonase®; Flovent®; Flutex®, Gynecort® [OTC]; Hemril-HC® Uniserts; Hexadrol®; Hi-Cor-1.0®; Hi-Cor-2.5®; Hydrocort®; Hydrocortone® Acetate; Hycort®; Hydrocortone® Phosphate; HydroSKIN®; HydroTex® [OTC]; Hytone®; I-Methasone®; Inflamase®; Forte Ophthalmic Inflamase® Mild Ophthalmic; Kenacort®; Kenaject-40®; Kenalog®; Kenalog-10®; Kenalog-40®; Kenalog® H; Kenalog® in Orabase®; Kenonel®; Key-Pred® Injection; Key-Pred-SP® Injection; LactiCare-HC®; Lanacort®[OTC]; Liquid Pred®; Locoid®; Maxidex®; Maxivate®; Medralone® Injection; Medrol® Oral; Methylone®; Metricorten®; Metreton® Ophthmalic; M-Prednisol® Injection; Nasacort®; Nasacort® AQ; Nasalide® Nasal Aerosol; Nasarel™; Nutracort®; Ocu-Dex®; Orabase® HCA; Orasone®; Pandel®; Peddiapred® Oral; Penecort®; Predair®; Predaject®; Predalone TBA®; Predcor®; Predcor-TBA®; Pred Forte® Ophthmalic; Pred Mild® Ophthmalic; Prednicen-M®; Prednisol® TBA Injection; Prelone® Oral; Procort® [OTC]; Proctocort™; Psorion® Cream; Pulmicort Turbuhaler®; Rhinocort®; Scalpicin®; Solu-Cortef®; Solu-Medrol® Injection; Solurex LA®; S-T Cort®; Sterapred®; Synacort®; Tac™-3; Tac™-40; Tegrin®-HC [OTC]; Teladar®; Triacet™; Triam-A®; Triam Forte®; Triderm®; Tri-Kort®; Trilog®; Trilone®; Tristoject®; U-Cort™; Valisone®; Westcort®

Use: Adrenocorticol hormone replacement insufficiency; used in rheumatic, autoimmune, dermatologic, collagen-vascular and other inflammatory diseases. Used in the treatment of hypercalcemia, as immunosuppressive agents including use in organ transplantation. Management of respiratory diseases including asthma, neoplastic diseases, and allergic disorders. Selected agents have been used in postherpetic neuralgia, meningitis, alcoholic hepatitis, and adult respiratory distress syndrome.

Pregnancy Risk Factor and Implications: B; some corticosteroids are known to enter breast milk/use caution.

Contraindications: Hypersensitivity to individual corticosteroid agents or formulations, fungal infections, serious infections (Note: There are specific exceptions to this general contraindication such as bacterial meningitis in selected patients).

Warnings/Precautions: Withdrawal of therapy must be done gradually, use may retard bone growth, use with caution in patients with hypothyroidism, cirrhosis, hypertension, congestive heart failure, diabetes mellitus, ulcerative colitis, thromboembolic disorders, and patients at risk for peptic ulcer disease. Use the lowest possible dose for the shortest possible period of time. Adverse effects may be particularly common in the elderly.

Adverse Reactions: Signs and symptoms of systemic hypercorticism and suppression of the adrenal-hypothalmic-pituitary axis may occur when used for prolonged periods. Cushingold appearance, muscle weakness, and osteoporosis may result. Individual corticosteroids may vary in their potential to cause specific adverse effects. The listing below provides only a general indication of the spectrum and frequency of adverse reactions to corticosteriods.

Greater than 10% experience:

Central nervous system: Insomnia, nervousness
Gastrointestinal: Increased appetite, indigestion

1% to 10% experience:

Dermatologic: Hirsutism
Endocrine & metabolic: Diabetes mellitus
Ocular: Cataracts, glaucoma
Neuromuscular & skeletal: Arthralgia
Respiratory: Epistaxis
Less than 1% experience: Edema, hypertension, vertigo, seizures, psychoses, pseudotumor cerebri, headache, mood swings, delirium, hallucinations, euphoria, acne, skin atrophy, bruising, hyperpigmentation, Cushing's syndrome, pituitary-adrenal axis suppression, growth suppression, glucose intolerance, hypokalemia, alkalosis, amenorrhea, sodium and water retention, hyperglycemia, peptic ulcer, nausea, vomiting, abdominal distention, ulcerative esophagitis, pancreatitis, muscle weakness, osteoporosis, fractures, muscle wasting, hypersensitivity reactions

Overdose/Toxicology:Symptoms of intoxication include cardia disturbances, CNS toxicity, bronchospasm, hypoglycemia, and hyperkalemia. The most common cardia symptoms include hypotension and bradycardia. Atrioventricular block, intraventricular conduction disturbances, cardiogenic shock, and asystle may occur with severe overdose, especially with membrane-depressant drugs (eg, propranolol). CNS effects include convulsions and coma. Respiratory arrest (commonly seen with propranolol and other membrane-depressant and lipid-soluble drugs). Treat symptomatically. Cardiac and hemdynamic monitoring may be necessary.

Theophylline

Nutrients Depleted: Vitamin B6.

U.S. Brand Names: Aerolate III®; Aerolate JR®; Aerolate SR®; Aquaphyllin®; Asmalix®; Bronkodyl; Elixomin®; Elixophyllin®; Lanophyllin®; Quibron®-T; Quibron®-T/SR; Respbid®; Slo-bid™; Slo-Phyllin®; Sustaire®; Theo-24®; Theobid®; Theochron®; Theoclear-80®; Theoclear® LA; Theo-Dur®; Theolair™; Theo-Sav®; Theospan®-SR; Thestat-80®; Theovent®; Theo-X®; T-Phyl®; Uni-Dur®; Uniphyl®

Use: Bronchodilator in reversible airway obstruction due to asthma, chronic bronchitis, or emphysema; for neonatal apnea/bradycardia.

Pregnancy Risk Factor and Implications: C; enters breast milk/compatible.

Contraindications: Uncontrolled arrythmias, hyperthyroidism, peptic ulcers, uncontrolled seizure disorders, hypersensitivity to xanthines or any component.

Warnings/Precautions: Use with caution in patients with peptic ulcer, hyperthyroidism, hypertension, tachyarrhythmias, and patients with compromised cardiac function; do not inject I.V. solution faster than 25 mg/minute; elderly, acutely ill, and patients with severe respiratory problems, pulmonary edema, or liver dysfunction are at greater risk of toxicity because of reduced drug clearance.

Although there is a great intersubject variability for half-lives of methylxanthines (2-10 hours), elderly as a group have slower hepatic clearance. Therefore, use lower initial doses and monitor closely for response and adverse reactions. Additionally, elderly are at greater risk for toxicity due to concomitant disease (eg, CHF, arrhythmias), and drug use )eg, cimetidine, ciprofloxacin, etc.)

Adverse Reactions: Uncommon at serum theophylline concentrations less than or equal to 20 mcg/mL

1% to 10%:

Cardiovascular: Tachycardia
Central nervous system: Nervousness, restlessness
Gastrointestinal: Nausea, vomiting

Less than 1%:

Central nervous system: Insomnia, irritability, seizures
Dermatologic: Skin rash
Gastrointestinal: Gastric irritation
Neuromuscular: Tremor
Miscellaneous: Allergic reactions

Overdose/Toxicology: Symptoms of overdose include nausea, vomiting, insomnia, irritability, tachycardia, seizures, tonic-clonic seizures, insomnia, and circulatory failure. If seizures have not occurred, induce vomiting; ipecac syrup is preferred. Do not induce emesis in the presence of impaired consciousness. Repeated doses of charcoal have been shown to be effective in enhancing the total body clearance of theophylline. Do not repeat charcoal doses if an ileus is present. Charcoal hemoperfusion may be considered if serum theophylline levels exceed 40 mcg/mL, the patient is unable to tolerate repeat oral charcoal administrations, or if severe toxic symptoms are present. Clearance with hemoperfusion is better than clearance from hemodialysis. Administer a carthartic, especially if sustained release agents were used. Phenobarbital administered prophylactically may prevent seizures.

Albuterol

U.S. Brand Names: Airet®; Albuterol Sulfate®; Anebron®; Asmalin®; Asmanil®; Butamol®; Proventil®; Salbusian®; Salbutamol®; Theosal®; Ventolin®; Ventolin Retocaps®; Volmax®

Use: A bronchodilator that relaxes the muscles in the airways to improve breathing. Used to treat asthma, bronchitis, and emphysema.

Pregnancy Risk Factor and Implications: Category C; unknown if albuterol will harm fetus, consult with doctor; unknown if albuterol enters breast milk, consult with doctor.

Contraindications: Do not use if you have had a previous allergic reaction to albuterol or to any of its components. Albuterol inhalation is not for us in children younger than 4 years of age.

Warnings/Precautions: Tell your doctor if you have heart disease, high blood pressure, epilepsy or another seizure disorder, diabetes, an overactive thyroid, or any type of liver or kidney disease before beginning treatment with this drug. Albuterol can produce paradoxical bronchospasm, which may be life threatening. Discontinue use of the drug immediately if this occurs. Fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs and with the home use of nebulizers. If asthma worsens while being treated with albuterol and you find that you are using more of the drug than usual to keep your asthma in control, consult with a doctor about alternative treatments.

Adverse Reactions: Allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue, or face, or hives), chest pain or irregular heartbeats, headache, dizziness, lightheadedness, insomnia, tremor, nervousness, sweating, nausea, vomiting, diarrhea, dry mouth.

Drug interactions: This drug interacts with beta-blockers, tricyclic antidepressants, MAOI, another inhaled bronchodilator, caffeine, diet pills, and decongestants. Consult with a doctor before using these drugs together.

Overdose/Toxicology: Overdose: Symptoms of an albuterol overdose include angina or chest pain, irregular heartbeats or a fluttering heart, seizures, tremor, weakness, headache, nausea, and vomiting.

Ipratropium bromide

U.S. Brand Names: Atrovent®

Use: Used to prevent bronchospasms (not intended for use during acute bronchospastic attacks). Prevents narrowing of the airways and increases air flow to the lungs. Used to treat lung diseases such as chronic bronchitis, emphysema, and sometimes asthma.

Pregnancy Risk Factor and Implications: B; unlikely to harm an unborn baby, consult with doctor. Unknown if passes into breast milk, consult with doctor.

Contraindications: Do not use if you have a soya lecithin allergy (allergy to soybeans or peanuts), tell your doctor if you have narrow angle glaucoma, an enlarged prostate or a bladder obstruction, do not use in children younger than 12 years of age.
 

Adverse Reactions: An allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue, or face, or hives), a racing heart rate, headache or dizziness, dry mouth, cough, hoarseness, nausea, vomiting, constipation, blurred vision.
 

Drug Interactions: This drug interacts with atropine, belladonna, clidinium (Donnatel), dicyclimine (Quarzan), popantheline (ProBanthine), mepenzolate (Cantil), methantheline (Banthine), methscopolemine (Pamine), scopolamine (Transderm-Scop). Consult with a doctor before using these drugs together.
 

Overdose/Toxicology: Call your doctor or poison control center for advice if you suspect an overdose. No symptoms of an ipratropium inhalation overdose have been reported in the past, and it is unlikely that an overdose of this drug will be fatal.

Ipratropium bromide

U.S. Brand Names: Intal®; Intal Inhaler®

Use: An anti-inflammatory medication that prevents the release of substances in the body that cause inflammation. Used as an inhalant to prevent asthma attacks (will not stop an asthma attack that has already started. Also used to treat other conditions involving inflammation of the lung tissues.

Pregnancy Risk Factor and Implications: B; unlikely to harm an unborn baby, consult with your doctor before using. Unknown if enters breast milk, consult with doctor.

Contraindications: Tell your doctor if you have kidney disease, liver disease, heart disease, or any other serious illness before beginning treatment with this medication.
 

Adverse Reactions: Seek emergency medical attention if you experience an allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue, or face, or hives). Less serious side effects may include dry mouth, nose, or throat after use, coughing or throat irritation, hoarseness or deepening of the voice, wheezing, increased pressure in the eyes, glaucoma, or tearing of the eyes, headache, dizziness, or lightheadedness, unpleasant (or loss of) taste or smell, nausea, joint swelling or pain, stuffy nose, or rash or itching.
 

Warnings/Precautions: Do not use more of this medication than is prescribed for you, too much may cause serious side effects. Seek medical attention if you notice that you require more than your usual or more than the maximum amount of an asthma medication in a 24-hour period, an increased need for medication could be an early sign of a serious asthma attack.
 

Overdose/Toxicology: An overdose of this medication if unlikely. If you suspect an overdose, call an emergency room or poison control center.

Nedocromil

U.S. Brand Names: Tilade®

Use: Anti-inflammatory medication, prevents the release of substances in the body that cause inflammation. Used as an inhalant to prevent asthma attacks and other conditions involving inflammation of the lung tissues (will not stop an asthma attack that has already started).

Pregnancy Risk Factor and Implications: B; unlikely to harm an unborn baby, consult with doctor. Unknown if enters breast milk, consult with doctor.

Contraindications: Do not use more of the medication than is prescribed for you, too much may cause serious side effects. Tell you doctor if you have kidney disease, liver disease, heart disease, or any other serious illness before beginning treatment with this drug. Do not use in children younger than 6 years of age.

Warnings/Precautions: Seek emergency medical attention if you notice that you require more than you usual or more than the maximum amount of an asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack. Tell your doctor about any other drugs you are taking before beginning treatment with this drug.

Adverse Reactions: Seek emergency medical attention if you experience an allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue, or face, or hives.) Other less serious side effects may include a dry mouth, an unpleasant taste, or mild nausea after use.

Overdose/Toxicology: An overdose of this medication is not likely to occur. If you suspect an overdose, call an emergency room or poison control center.

Salmeterol

U.S. Brand Names: Serevent®; Serevent Diskus®

Use: Bronchodilator, works by relaxing the muscles in the airways to improve breathing. Used only to pr