Microsoft word - english_med_rc_0406.doc

WOMEN'S INTERAGENCY HIV STUDY
ENGLISH VERSION
MEDICATION RESPONSE CARDS
RESPONSE CARD D1
1. Rarely
2. Sometimes
Form 22MED: Medication Use, Question B7b RESPONSE CARD D2
2. Some of the time
3. About half of the time
4. Most of the time
5. All of the time
RESPONSE CARD D3
1. I am HIV negative
2. My CD4 was too high / my viral load was too low
3. I feel too healthy
4. I am taking alternative medications
5. I don't want side effects
6. They are too hard to swallow
7. My doctor did not prescribe them
8. I can't afford them / have no insurance coverage
9. Concerned about resistance
10. I'm having a baby
11. Personal decision to wait
12. Didn't work for my friends
14. Liver problems
13. Any other reason
Form 22MED: Medication Use, Question B10 RESPONSE CARD D4
A. Inhaled
Medications
Pentamidine
(aerosolized)
B. Injected or infused drugs
Foscavir (foscarnet)
Ganciclovir (DHPG, Cytovene IV)
Nandrolone
(Deca-durabolin)
Medication to increase white blood cell count (G-
CSF, GM-CSF, Neupogen)
Medication to increase red blood cell count
(erythropoietin, Epogen, Procrit, Epo)
Interferon alfa-2b (Intron A)
Amphotericin B (Ampho B)
Pegylated interferon (PEGASYS, Peg-intron,
peginterferon alfa-2a, peginterferon alfa-2b)
RESPONSE CARD D4 (continued)
C. Pills, Liquids or Creams
Bactrim (Septra, cotrimoxazole, trimethoprim-
sulfamethoxazole, TMP/SMZ)
(clarithromycin)
(ciprofloxacin)
Diflucan
(fluconazole)
(famciclovir)
Ganciclovir (Cytovene, valganciclovir, Valcyte)
(isoniazid)
Lamprene
(clofazimine)
(atovaquone)
Methadone
Monistat
(miconazole)
Myambutol
(ethambutol)
Mycelex or lotrimin (clotrimazole)
RESPONSE CARD D4 (continued)
C. Pills, Liquids or Creams (continued)
(ketoconazole)
Nystatin (mycostatin)
Oxandrin
(oxandrolone)
Prednisone
(Deltasone)
(pyrazinamide)
Rebetron (ribivirin & interferon alfa-2b)
Rifabutin
(mycobutin)
(rifampin)
Sporanox
(itraconazole)
(terconazole)
(valacyclovir)
(voriconazole)
Zithromax
(azithromycin)
(acyclovir)
RESPONSE CARD D4a
Hepatitis Medications
Interferon alfa-2b (Intron A)
Pegylated interferon (PEGASYS or Peginterferon
alfa-2a) (PEG-Intron or Peginterferon alfa-2b)
Ribavirin (Virazole, Rebetol, Copegus)
Rebetron (Ribavirin and interferon alfa-2b)
Epivir (lamivudine, 3-TC)
Viread (tenofovir)
Hespera (adefovir, Preveon)
Emtriva (Coviracil, emtricitabine, FTC)
Infergen (interferon alfacon-1)
Famvir (famciclovir)
Truvada (Viread + Emtriva)
Baraclude (entecavir)
RESPONSE CARD D4h
Hormone Replacement Therapies
Estrogen: Premarin, Estrace, Estratab, Menest,
Ogen, Cenestin, Estraderm, Climera, Menostar,
Estrasorb
Progesterone: Provera, Cycrin, Amen, Prometrium,
Micronor, Nor-QD
Combination Estrogen/Progesterone: Premphase,
Prempro, Combipatch
Other Hormone Replacement Therapy: Tamoxifen,
Raloxifene, testosterone patch or cream, Estratest
(combination estrogen / testosterone), birth
control pills, Norplant, Ortho Evra (birth control
patch), NuvaRing (a vaginal ring containing
hormone)
Form 22MED: Medication History, Question E8 RESPONSE CARD D4b
Heart and Blood Pressure Medications
Cordarone, Pacerone (amiodarone)
Cardioquin, Quinaglute, Quinidex (quinidine)
Calan, Verelan, Isoptin (verapamil)
Cardizem, Dilacor, (diltiazem)
Cardene (nicardipine)
Procardia, Adalat (nifedipine)
Plendil (felodipine)
Norvasc (amlodipine)
Tenormin (atenolol)
Inderal (propranolol)
Lotensin (benazepril)
Lopressor, Toprol (metropolol)
Capoten (captopril)
Zestril, Prinivil (lisinopril)
Vasotec (enalapril)
Altace (ramipril)
Accupril (quinapril)
Monopril (fosinopril)
digoxin (Digitek, Lanoxin, Lanoxicaps)
nitroglycerin (Nitro-Bid, Nitrocine, Nitroglyn, Nitrolingual, Nitrong,
Nitrostat)
Catapres (clonidine)
Cozaar (losartan)
Hyzaar (losartan + hydrochorothiazide)
Form 22MED: Medication Use, Question E10a RESPONSE CARD D4c
Cholesterol, Triglyceride and Lipid Medications
Lescol (fluvastatin)
Lipitor (atorvastatin)
Mevacor, Altocor (lovastatin)
Pravachol (pravastatin)
Zocor (simvastatin)
Crestor (rosuvastatin)
Lopid (gemfibrozil)
TriCor (fenofibrate)
Colestid (colestipol)
Questran (cholestyramine)
Welchol (colesevelam)
Niaspan (niacin)
Zetia (ezetimibe)
Caduet (amlodipine + atorvastatin)
Vytorin (ezetimibe + simvastatin)
Advicor (lovastatin + niacin)
Pravigard (pravastatin + buffered aspirin)
Form 22MED: Medication Use, Question E10b RESPONSE CARD D4d
Blood Sugar or Diabetes Medications
Insulin (injection)
Byetta (exenatide, injection)
Symlin (pramlintide, injection)
Precose (arcarbose)
Diabinese (chlorpropamide)
Amaryl (glimepiride)
Glucotrol (glipizide)
Micronase, Diabeta, Glynase (glyburide)
Glucophage (metformin)
Glyset (miglitiol)
Actos (pioglitazone)
Prandin (repaglinide)
Avandia (rosiglitazone)
Starlix (nateglinide)
Tolinase (tolazamide)
Tol-Tab (tolbutamide)
Dymelor (acetohexamide)
Avandamet (metformin + rosiglitazone)
Metaglip (metformin + glipizide)
Glucovance (metformin + glyburide)
Form 22MED: Medication Use, Question E10c RESPONSE CARD D4e
Osteoporosis Medications
Fosamax, Fosamax Plus D (alendronate)
Evista (raloxifene)
Forteo (teriparatide)
Miacalcin (calcitonin)
Boniva (ibandronate)
Form 22MED: Medication Use, Question E10d RESPONSE CARD D4f
Seizure Medications
Tegretol, Carbatrol, Epitol, Equetrol (carbamazepine)
Dilantin, Phenytek (phenytoin)
Felbatol (felbamate)
Mysoline (primidone)
Topamax (topiramate)
Mebaral (mephobarbital)
Solfoton (Phenobarbital)
Depakote, Depacon, Depakene (valproic acid, valproate)
Klonapin (clonazepam)
Cerbyx (fosphenyton)
Neurontin (gabapentin)
Lamictal (lamotrigine)
Pentothal (thiopental)
Form 22MED: Medication Use, Question E10e RESPONSE CARD D4g
Psych Medications
Zyprexa (olanzapine)
Serzone (nefazodone)
Luvox (fluvoxamine)
Zoloft (sertraline)
Celexa (citalopram)
Wellbutrin, Zyban (bupropion)
Lexapro (escitalopram)
Prozac, Sarafem (fluoxetine)
Paxil (paroxetine)
Effexor (venlafaxine)
Symbyax (Prozac + Zyprexa)
Cymbalta (duloxetine)
Elavil (amitriptyline)
Norpramin (desipramine)
Tofravil (imipramine)
Remeron (mirtazapine)
Aventyl (nortriptyline)
Desyrel, Dividose (trazodone)
Sinequan (doxepin)
Seroquel (quetiapine)
Risperdal (risperidone)
Haldol (haloperidol)
Abilify (aripiprazole)
Form 22MED: Medication Use, Question E10f RESPONSE CARD D4i
Medications for Lipodystrophy / Body Fat Changes
Protropin (somatrem)
Serostim, Genotropin, Humatrope, Norditropin, Nutropin, Saizen
(somatropin)
Megace (megestrolacetate)
Avandia (rosiglitazone)
Glucophage (metformin)
Form 22MED: Medication Use, Question E10g RESPONSE CARD D5
Enzyme therapies (plant or pancreatic)
Flower remedies
Chinese herbs in combination
Echinacea (with or without goldenseal)
Milk thistle
St. John's Wort (hypericin)
Homeopathic remedies
Nutritional Supplements
Aciophilus
A-vitamins
Beta-carotene
B-complex
B-vitamins (B1 thiamine, B2 riboflavin, B5
pantothenic acid, B6 pyridoxine, B12)
RESPONSE CARD D5 (continued)
Nutritional Supplements (continued)
C-vitamins (rosehips)
Coenzyme Q-10
E-vitamins
Folic acid
Multivitamins / minerals
Megadose vitamins
Omega-3 type oils
Protein powder
Other Complementary / Alternative Treatments
NAC (N-acetyl-cysteine)
Thymus glandular
RESPONSE CARD D6
1. To treat or reduce side effects from standard
medications
2. To boost immune system
3. To prevent opportunistic and general infections
4. To treat HIV infection
5. For general health
6. Beneficial without causing side effects
7. Standard HIV medications don't work
8. To gain weight
9. To lose weight
RESPONSE CARD E1
1. 1 week or less
2. More than 1 week but less than 1 month
3. 1 - 2 months
4. 3 - 4 months
5. 5 - 6 months
6. More than 6 months
Drug Form 1: Antiretroviral Medications, Question 3 Drug Form 2: Non-antiviral Medications, Question 4 RESPONSE CARD E4
5% 15% 25% 35% 45% 55% 65% 75% 85% 95%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Drug Form 1: Antiretroviral Medications, Questions 7, 8, 9 RESPONSE CARD E5
2. Yesterday
3. Earlier this week
5. Less than a month ago
6. More than a month ago
Drug Form 1: Antiretroviral Medications, Question 10 RESPONSE CARD E6
5% 15% 25% 35% 45% 55% 65% 75% 85% 95%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Drug Form 1: Antiretroviral Medications, Question 11

Source: http://statepiaps.jhsph.edu/wihs/visitforms/v24/response-cards/english_med_RC_0406.pdf