Flashcards

Drug Receptor Types Functions of Peripheral Adrenergic Receptor Subtypes

Functions of Peripheral Cholinergic Receptor Subtypes

Receptor Subtype

Receptor Subtype

Location

Response to Receptor Activation Mydriasis—wide eyed with fear Mydriasis—wide Constriction

Alpha2

Eye Arterioles (skin, viscera, mucous membranes) Veins Sex organs, male Bladder neck and prostatic capsule Presynaptic nerve terminals

Beta1

Heart

Alpha1

Beta2

Dopamine

Kidney Arterioles (heart, lung, and skeletal mucle) Bronchi Uterus Liver Skeletal muscle Kidney

Constriction Ejaculation Contraction Inhibition of transmitter release—decreases release—decreases sympathetic nervous system (SNS) out flow to the blood vessels and heart Increased rate, force of contraction, and AV conduction velocity Renin release— RAS Dilation

Nicotinicn

e r e h d l o F

Location

Response to Receptor Activation

All autonomic nervous system ganglia and the adrenal medulla

Stimulation of parasympathetic and sympathetic postganglionic nerves and release of epinephrine from the adrenal medulla Contraction of skeletal muscle

Nicotinicm Neuromuscular junction Muscarinic All parasympathetic target organs: Eye Heart Lung Bladder GI tract

Dilation Relaxation Glycogenolysis Enhanced contraction, glycogenolysis Dilation of kidney vasculature

Sweat glands Sex organs Blood vessels

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Miosis Decreased rate Constriction of bronchi Promotion of secretions Voiding Salivation Increases gastric secretions, intestinal tone, and motility Defecation Generalized sweating Erection Vasodilation

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Drug Endings

Drug Endings—cont’d

Drug Endings

Drug Classification

Drug Example

-zosin -olol, -lol -zepam, -zolam -pril -artan -dipine -statin -ase, -plase -parin -sone -dronate

Alpha-adrenergic blocker Beta-adrenergic blocker Benzodiazepine (BZD) Angiotensin-converting Angiotensin-c onverting enzyme (ACE) inhibitor Angiotensin-receptor blocker (ARB) Calcium channel blocker Lipid-lowering Lipid-lowerin g drug Thrombolytic Anticoagulant Corticosteroid Bisphosphonate for osteoporosis

pra zosin metopr olol dia zepam , alpra zolam lisino pril candes artan amlo dipine atorva statin alte plase enoxa parin sone predni sone alen dronate Continued

Copyright © 2007 by Saunders, an imprint of Elsevier Inc

e r e h d l o F

Drug Endings

Drug Classification

Drug Example

-terol -tidine -prazole -cillin -cef, -ceph -cycline -floxacin -thromycin -micin, -mycin -azole

Bronchodilator Histamine2 blocker–acid reducer Protein pump inhibitor–acid reducer Penicillin antibiotic Cephalosporin Cephalospori n antibiotic Tetracycline antibiotic Fluoroquinolone antibiotic Macrolide antibiotic Aminoglycosidee antibiotic Aminoglycosid Antifungal

albu terol cime tidine ome prazole cillin amoxi cillin cef azolin azolin tetra cycline levo floxacin thromycin azi thromycin genta mycin itracon azole

BETHANECHOL (URECHOLINE)

BETHANECHOL (URECHOLINE) Muscarinic Agonist

Muscarinic Agonist

Activates muscarinic receptors Causes contraction of the detrusor muscle of the bladder e r e h d l o F

Uses Postoperative urinary retention

Adverse Effects Hypotension Bradycardia, dysrhythmias Bronchoconstriction GI effects

Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

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ATROPINE

ATROPINE Muscarinic Antagonist (Anticholinerg (Anticholinergic) ic)

Muscarinic Antagonist (Anticholinerg (Anticholinergic) ic)

e r e h d l o F

Blocks muscarinic receptors Increases heart rate Decreases salivary, bronchial, sweat, and acid-secreting cell secretions Relaxes bronchial smooth muscles Decreases bladder tone and GI motility Dilates pupils (mydriasis)

Uses Preanesthesia to prevent bradycardia, treatment of bradycardia Dilation of pupil for ocular examination or surgery Intestinal hypertonicity and hypermotility Antidote for muscarinic-agonist poisoning

Adverse Effects Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

Blurry vision, urinary retention, dry mouth, constipation, tachycardia

NEOSTIGMINE (PROSTIGMINE)

NEOSTIGMINE (PROSTIGMINE) Reversible Cholinesterase Inhibitor

Reversible Cholinesterase Inhibitor

Prevents the degradation of acetylcholine (ACh) Enhances the effect of ACh to stimulate skeletal muscle e r e h d l o F

Uses Myasthenia gravis Reversal of neuromuscular blockade in postoperative patients

Adverse Effects Excessive glandular secretions, increased GI motility Urinary urgency, bradycardia, sweating, and miosis Cholinergic crisis—treat with atropine


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SUCCINYLCHOLINE

SUCCINYLCHOLINE Depolarizing Neuromuscular Blocker

Depolarizing Neuromuscular Blocker

Causes paralysis of muscle by preventing repolarization

Uses e r e h d l o F


Muscle relaxation during endotracheal intubation Used for short operative procedures

Adverse Effects Prolonged paralysis in genetically determined individuals Malignant hyperthermia—treat with dantrolene Muscle pain, hyperkalemia

PHENYLEPHRINE

PHENYLEPHRINE Adrenergic Agonist

Adrenergic Agonist

Activates alpha1 receptors Constricts blood vessels of the skin, viscera, and mucous membranes e r e h d l o F

Uses Treatment of nasal congestion Delay of anesthetic absorption Dilation of the pupil for ocular exam

Adverse Effects Hypertension Necrosis


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EPINEPHRINE

EPINEPHRINE Adrenergicc Agonist (Catecholamine) Adrenergi

Adrenergic Agonist (Catecholamin (Catecholamine) e)

e r e h d l o F

Activates all four adrenergic receptors—alpha1, alpha2, beta1, and beta2 Pupil dilation, arterial and venous vasoconstriction Increases heart rate and force of contraction Bronchial dilation, glycogenolysis, enhanced muscle contraction

Uses Cardiac arrest, heart failure, and anaphylactic shock AV heart block and asthma asthma Delays absorption of local anesthetic and controls superficial bleeding Reduces nasal congestion Dilates pupil for eye procedures


Hypertension, tachycardia, and dysrhythmias Angina, necrosis following extravasation

PROPRANOLOL (INDERAL) Adrenergic Antagonist Noncardioselective Noncardio selective Beta Blocker

PROPRANOLOL (INDERAL) Adrenergic Antagonist Noncardioselective Beta Blocker Noncardioselective e r e h d l o F

Blocks beta1 and beta2 receptors Reduces heart rate, decreases force of ventricular contraction Decreases conduction through AV AV node, decreases cardiac output Suppresses renin, bronchoconstriction

Uses Angina, hypertension, cardiac dysrhythmias Myocardial infarction, heart failure, hyperthyroidism, glaucoma

Adverse Effects


Bradycardia, reduced cardiac output, AV heart block Rebound cardiac excitation, bronchoconstriction Inhibition of glycogenolysis, CNS effects Not used in patients with asthma or diabetes

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METOPROLOL (LOPRESSOR, TOPROL XL)

METOPROLOL (LOPRESSOR, TOPROL XL) Adrenergic Antagonist Cardioselective Cardioselec tive Beta Blocker

Adrenergic Antagonist Cardioselective Beta Blocker Cardioselective e r e h d l o F

Blocks cardiac beta1 receptors Reduces heart rate, decreases force of ventricular contraction Decreases conduction through AV AV node, decreases cardiac output Suppresses renin Does not block beta2 receptors (no bronchoconstriction) Not likely to inhibit glycogenolysis Preferred for patients with asthma or diabetes

Uses Hypertension, angina pectoris, heart failure


Bradycardia, reduction of cardiac output, AV AV heart block Rebound cardiac excitation following abrupt withdrawal

PRAZOSIN (MINIPRESS)

PRAZOSIN (MINIPRESS) Adrenergic Antagonist Alpha blocker

Adrenergic Antagonist Alpha Blocker e r e h d l o F

Blocks alpha1 receptors Dilates arteries and veins Relaxes smooth muscle in the bladder neck and prostatic capsule

Uses Hypertension Benign prostatic hypertrophy

Adverse Effects


Orthostatic hypotension, reflex tachycardia Inhibition of ejaculation Nasal congestion Use with sildenafil (Viagra), other drugs for erectile dysfunction, can lead to hypotension

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CLONIDINE (CATAPRES)

CLONIDINE (CATAPRES) Centrally Acting Alpha 2 Agonist Antihypertensive Antihypertensiv e Drug

Centrally Acting Alpha 2 Agonist Antihypertensive Antihyperten sive Drug e r e h d l o F

Activates alpha2 receptors in the CNS Reduces sympathetic flow to the heart and blood vessels Reduces stimulation of adrenergic receptors in the periphery Net effect of cardiac suppression and vasodilation is decreased blood pressure

Uses Hypertension

Adverse Effects


Hypotension Bradycardia, decrease in cardiac output Drowsiness, dry mouth Rebound hypertension in response to abrupt withdrawal

LEVODOPA/CARBIDOPA (SINEMET)

LEVODOPA/CARBIDOPA (SINEMET) Dopaminergic Agent

Dopaminergic Agent

Levodopa increases synthesis of dopamine in the striatum Carbidopa enhances the effect of levodopa e r e h d l o F

Uses Reduces symptoms of Parkinson’s disease

Adverse Effects Effects take several months to develop Loss of effect occurs over time Nausea, vomiting, dyskinesias Postural hypotension, psychosis Dark sweat and urine, may activate melanoma


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DONEPEZIL (ARICEPT)

DONEPEZIL (ARICEPT) Cholinesterase Inhibitor Cholinesterase

Cholinesterase Inhibitor

e r e h d l o F

Prevents the breakdown of ACh Increases ACh at cholinergic synapses May slow progression of Alzheimer’s disease (AD) Some improvement of cognitive function

Uses Alzheimer’s disease (AD)

Adverse Effects Cholinergic effects Nausea, vomiting, dyspepsia, diarrhea Bradycardia, bronchoconstriction


PHENYTOIN (DILANTIN)

PHENYTOIN (DILANTIN) Antiepileptic Drug (AED)

Antiepileptic Drug (AED)

Inhibits entry of sodium into neurons Suppresses action potential of neurons e r e h d l o F

Uses Epilepsy

Adverse Effects


Nystagmus, sedation, ataxia, diplopia Cognitive impairment, gingival hyperplasia, hirsutism Rash, fetal harm, bleeding tendencies in newborns Narrow therapeutic range (10 to 20 mcg/mL) Can decrease the effect of other drugs such as: Oral contraceptives, warfarin, and glucocorticoids Inject slowly, use normal saline flush Withdraw over a period of 6 to 8 weeks to avoid seizures

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VALPROIC ACID (DEPAKOTE)

VALPROIC ACID (DEPAKOTE) Antiepileptic Drug (AED)

Antiepileptic Drug (AED)

Blocks sodium channels to suppress neurons Suppresses calcium influx Increases inhibitory influence of gamma-aminobutyric acid (GABA) e r e h d l o F


Uses Epilepsy, bipolar disorder, migraine headaches

Adverse Effects Nausea, vomiting, indigestion Hepatotoxicity, pancreatitis, fetal harm Hepatotoxicity, Weight Weig ht gain, rash, hair loss, tremor Blood dyscrasias

MORPHINE

MORPHINE Opioid Analgesic

Opioid Analgesic

Activates mu receptors Produces analgesia, euphoria, sedation e r e h d l o F

Uses Relief of pain

Adverse Effects Respiratory depression, constipation Orthostatic hypotension, urinary retention, miosis Biliary colic, euphoria, sedation, c ough suppression Tolerance and physical dependence Reversed with naloxone (Narcan)


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NALOXONE (NARCAN)

NALOXONE (NARCAN) Opioid Antagonist

Opioid Antagonist

Reverses the effects of opioids



Opioid overdose Reversal of excessive respiratory depression

Adverse Effects Minimal

SUMATRIPTAN (IMITREX)

SUMATRIPTAN (IMITREX) Serotonin1B/1D-Receptor Agonist (Triptan)

Serotonin 1B/1D-Receptor Agonist (Triptan)

Binds to 5-HT1B/1D receptors to cause vasoconstriction Reduces release of inflammatory peptides Diminishes perivascular inflammation e r e h d l o F

Uses Migraine headache

Adverse Effects Chest pressure, coronary vasospasm Fetal harm


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CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)

CONVENTIONAL ANTIPSYCHOT ANTIPSYCHOTICS ICS (NEUROLEPTICS)

Chlorpromazine (Thorazine) Thioridazine (Mellaril) Haloperidol (Haldol)

Relieve positive symptoms of schizophrenia Block receptors for dopamine, acetylcholine (ACh), histamine, and norepinephrine (NE) e r e h d l o F


Uses Schizophrenia, bipolar disorder, Tourette’s syndrome, and dementia

Adverse Effects Extrapyramidal symptoms (EPS) (acute dystonia, parkinsonism, akathisia, tardive dyskinesia) Neuroleptic malignant syndrome Anticholinergic effects, orthostatic hypotension Sedation, neuroendocrine effects, seizures Sexual dysfunction, increased risk of sunburn Agranulocytosis, dysrhythmias

ATYPICAL ANTIPSYCHOTICS

ATYPICAL ANTIPSYCHOTICS

Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify)

Relieve positive and negative signs and symptoms of schizophrenia Block receptors for serotonin, dopamine, ACh, histamine, and NE Clinically superior to conventional antipsychotics


Schizophrenia

Adverse Effects Sedation, orthostatic hypotension, weight gain, dry mouth Blurry vision, urinary retention, constipation, tachycardia Galactorrhea, gynecomastia, amenorrhea, diabetes Agranulocytosis, seizures Low risk of extrapyramidal effects


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SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Antidepressants

Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro)

Antidepressants


Inhibit serotonin reuptake (more serotonin is available at the synapse) e r e h d l o F

Uses Major depression, OCD Panic disorder, PTSD, PMDD

Adverse Effects Sexual dysfunction, nausea, headache, insomnia Weight Weig ht gain, serotonin syndrome Withdrawal syndrome

TRICYCLIC ANTIDEPRESSANTS (TCAs)

TRICYCLIC ANTIDEPRESSANTS (TCAs) Antidepressants

Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan)

Antidepressants

Inhibit reuptake of NE and serotonin (more serotonin and NE available at the synapse) e r e h d l o F

Uses Depression, bipolar disorder, insomnia, and neuropathic pain

Adverse Effects Orthostatic hypotension, sedation Anticholinergic effects Cardiotoxicity,, se izures, hypomania Cardiotoxicity Many drug interactions SSRIs preferred for treatment of depression


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MONOAMINE OXIDASE INHIBITORS (MAOIs)

MONOAMINE OXIDASE INHIBITORS (MAOIs) Antidepressants

Antidepressants

Increase NE and serotonin by blocking enzyme that inactivates them



Depression

Adverse Effects CNS stimulation, orthostatic hypotension Hypertensive crisis from buildup of dietary tyramine Many drug interactions SSRIs preferred for treatment of depression

LITHIUM Mood-Stabilizing Drug Mood-Stabilizing

LITHIUM Mood-Stabilizing Mood-Stabiliz ing Drug

Mechanism unclear, may alter ions and neurotransmitters



Stabilizes mood in patients with bipolar disorder Reduces euphoria, hyperactivity, and other symptoms Preferred for patients with classic (euphoric) mania

Adverse Effects Accumulates to toxic levels in the presence of a low sodium level Lithium levels must be kept below 1.5 mEq/L Blood levels drawn 12 hours after evening dose Signs of toxicity include fine hand tremor, GI upset, thirst, polyuria, and muscle weakness Chronic use can lead to renal toxicity and hypothyroidism Pregnancy Risk Category D Drug interactions occur with diuretics, NSAIDs, and anticholinergics

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VALPROIC ACID (DEPAKOTE)

VALPROIC ACID (DEPAKOTE) Mood-Stabilizing Anticonvulsant Mood-Stabilizing

Mood-Stabilizing Mood-Stabiliz ing Anticonvulsan Anticonvulsantt

Suppresses mania and stabilizes mood



Mood stabilizer for patients with bipolar disorder

Adverse Effects GI disturbances, weight gain Rare thrombocytopenia, pancreatitis, liver failure Target trough level is 50 to 125 mg/mL

LAMOTRIGINE (LAMICTAL)

LAMOTRIGINE (LAMICTAL) Newer Mood-Stabilizing Anticonvulsan Anticonvulsantt

Newer Mood-Stabilizing Anticonvulsant

Shows some efficacy in treating bipolar disorder


Bipolar disorder

Adverse Effects Headache, dizziness, double vision Life-threatening rashes include Stevens-Johnson syndrome and epidermal necrolysis


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BENZODIAZEPINES BENZODIAZEPI NES (BZDs)

BENZODIAZEPINES (BZDs) BENZODIAZEPINES Sedative Hypnotic Drugs

Alprazolam (Xanax) Diazepam (Valium) Flurazepam (Dalmane) Lorazepam (Ativan) Midazolam (Versed) Temazepam (Restoril)

Sedative-Hypnotic Sedative-Hypn otic Drugs


Depress central nervous system function Reduce anxiety, promote sleep Potentiate the actions of GABA (an inhibitory neurotransmitter) neurotransmitter) e r e h d l o F

Uses Anxiety,, insomnia, seiz ure disorder, induction of anesthesia Anxiety Muscle spasm, panic disorder, and withdrawal from alcohol

Adverse Effects CNS depression, anterograde amnesia, paradoxic effects Weak respiratory depression if given orally IV administration can cause severe respiratory depression depression Abuse and addiction, teratogenic Do not mix with other CNS depressants or alcohol Reversal agent is flumazenil (Romazicon)

ZOLPIDEM (AMBIEN) ZALEPLON (SONAT (SONATA) A)

ZOLPIDEM (AMBIEN) Sedative-Hypnotics BZD-like Drugs

Sedative-Hypnotics BZD-like Drugs

Potentiate the actions of GABA (an inhibitory neurotransmitter) neurotransmitter) e r e h d l o F

Uses Short-term management of insomnia

Adverse Effects Daytime drowsiness, dizziness Do not use with alcohol or other CNS depressants


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BARBITURATES

BARBITURATES CNS Depressants

Thiopental (Pentothal) Secobarbital (Seconal) Phenobarbital

Potentiate the actions of GABA (an inhibitory neurotransmitter) neurotransmitter)

Uses

CNS Depressants

e r e h d l o F


Insomnia Suppression of seizures, induction of general anesthesia

Adverse Effects Respiratory depression, decreased blood pressure and heart rate Induction of hepatic drug-metabolizing enzymes (increases the metabolism of other drugs) May lead to tolerance and dependence Frequently used as vehicles for suicide Teratogenic

METHYLPHENIDATE (RITALIN, METADA ME TADATE, TE, CONCERTA)

METHYLPHENIDATE (RITALIN, METADA ME TADATE, TE, CONCERTA) CNS Stimulant for ADHD

CNS Stimulant for ADHD

Promotes norepinephrine (NE) and dopamine (DA) release Inhibits NE and DA reuptake e r e h d l o F

Uses Attention deficit/hyperactivity disorder (ADHD) Narcolepsy

Adverse Effects Insomnia, reduced appetite, palpitations, hypertension, angina, dysrhythmias, psychosis Abrupt discontinuation can lead to withdrawal reactions Potential for abuse (Schedule II) Sudden death


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ATOMOXETINE (STRATTERA)

ATOMOXETINE (STRATTERA) Nonstimulant Drug for ADHD

Nonstimulant Drug for ADHD

Selective inhibitor of NE reuptake Causes NE to accumulate at synapses e r e h d l o F


Uses ADHD in children and adults

Adverse Effects GI reactions, reduced appetite, dizziness, and s omnolence Urinary retention, mood swings, insomnia, sexual dysfunction

ADDERALL

ADDERALL CNS Stimulant Used for ADHD Combination Amphetamine

CNS Stimulant Used for ADHD Combination Amphetamine


ADHD

Adverse Effects Insomnia, growth suppression Headache, abdominal pain, lethargy Abuse potential (Schedule II) Sudden death Drug holidays recommended


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DISULFIRAM (ANTABUSE)

DISULFIRAM (ANTABUSE) Aversion Therapy for Alcoholism

Aversion Therapy for Alcoholism

Disrupts alcohol metabolism by blocking enzyme Aldehyde accumulates and produces unpleasant effects e r e h d l o F


Uses Alcohol abuse

Adverse Effects Nausea, vomiting, flushing, palpitations, headache Sweating, blurry vision, hypotension, chest pain, s hock will occur with 7 mL mL of alcohol ingestion

FUROSEMIDE (LASIX)

FUROSEMIDE (LASIX) Loop Diuretic

Loop Diuretic

Blocks reabsorption of sodium and chloride in the descending limb of the loop of Henle to promote urination Produces profound diuresis e r e h d l o F

Uses Rapid mobilization of fluid Pulmonary edema resulting from heart failure or renal or liver disease Especially useful in patients with renal insufficiency

Adverse Effects Hypokalemia, hyponatremia, hypochloremia, dehydration, hypotension, and ototoxicity May cause dysrhythmias when used with digoxin (decreases potassium) Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

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HYDROCHLOROTHIAZIDE HYDROCHLORO THIAZIDE (HCTZ)

HYDROCHLOROTHIAZIDE (HCTZ) HYDROCHLOROTHIAZIDE Thiazide Diuretic

Thiazide Diuretic

Blocks reabsorption of sodium and chloride in the early segment of the distal convoluting tubule to promote urination e r e h d l o F


Uses Treatment of hypertension Mobilization of edema with mild heart failure, hepatic or renal disease

Adverse Effects Hyponatremia, hypochloremia, dehydration Hypokalemia and hypotension

SPIRONOLACTONE (ALDACTONE)

SPIRONOLACTONE (ALDACTONE) SPIRONOLACTONE Potassium-Sparing Potassium-Spa ring Diuretic

Potassium-Sparing Potassium-Spa ring Diuretic

Blocks the actions of aldosterone in the distal nephron Causes the retention of potassium and increased excretion of sodium e r e h d l o F

Uses Hypertension and edema Heart failure Primary hyperaldosteronism

Adverse Effects Endocrine effects such as: Gynecomastia, menstrual irregularities, impotence, and hirsutism Hyperkalemia


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ENALAPRIL (VASOTEC)

ENALAPRIL (VASOTEC) Angiotensin-Converting Enzyme (ACE) Inhibitor Angiotensin-Converting

Benazepril (Lotensin) Fosinopril (Monopril) Lisinopril (Prinivil and Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)

e r e h

Angiotensin-Converting Angiotensin-C onverting Enzyme (ACE) Inhibitors

d l o F

Inhibits ACE, reducing levels of angiotensin II Dilates arterioles and veins to reduce BP Reduces blood volume

Uses Hypertension, heart failure, MI, diabetic nephropathy Prevention of MI, stroke, and death

Adverse Effects Hypotension, cough, hyperkalemia Renal failure in patients with renal artery stenosis Fetal injury Angioedema


LOSARTAN (COZAAR)

LOSARTAN (COZAAR) Angiotensin II-Receptor Blocker (ARB)

Candesartan (Atacand) Eprosartan (Teveten) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan)

Angiotensin II-Receptor Blockers (ARBs)

Blocks the actions of angiotensin II Dilates arterioles and veins to reduce BP Reduces blood volume e r e h d l o F

Uses Hypertension, heart failure, MI, and diabetic nephropathy Prevention of MI, stroke, and death

Adverse Effects Renal failure in patients with renal artery stenosis Hypotension Angioedema Fetal injury Does not cause cough or hyperkalemia


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VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM)

VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM) Calcium Channel Blockers (CCBs) Nondihydropyridines

Calcium Channel Blockers (CCBs) Nondihydropyridines e r e h d l o F

Block calcium channels in the heart and blood vessels Reduce BP by blocking calcium channels in the the arterioles Increase coronary perfusion Block SA and AV nodes to reduce heart rate and contractility Decrease force of contraction

Uses Angina, hypertension, cardiac dysrhythmias


Constipation, dizziness, facial flushing, edema, hypotension Bradycardia, AV AV block, decreased cardiac contractility

AMLODIPINE (NORVASC)

AMLODIPINE (NORVASC) Calcium Channel Blocker

Calcium Channel Blocker Dihydropyridine

Dihydropyridine e r e h d l o F

Blocks calcium channels in the blood vessels Vasodilation in peripheral arterioles lowers blood pressure

Uses Hypertension Angina

Adverse Effects Peripheral edema, flushing, dizziness, headache Does not slow heart rate like nondihydropyridines Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

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DIGOXIN (LANOXIN)

DIGOXIN (LANOXIN) Cardiac Glycoside Positive Inotropic Agent Drug for Heart Failure

Cardiac Glycoside Positive Inotropic Agent Drug for Heart Failure e r e h d l o F

Increases the force of ventricular contraction Inhibits Na, K-ATPase to increase Ca  inside myocytes Competes with K for binding to Na, K-ATPase ↓K → ↑ Na, K-ATPase inhibition → digoxin toxicity Changes electrical electrical activity of the heart and slows heart rate

Uses Heart failure and dysrhythmias

Adverse Effects


Anorexia, nausea and vomiting, fatigue Visual disturbances (blurry vision, yellow tinge, halos) Dysrhythmias Digoxin toxicity (therapeutic level 0.5 to 0.8 ng/mL) Hold if HR 60 BPM or K  is low

AMIODARONE (CORDARONE)

AMIODARONE (CORDARONE) Antidysrhythmic Class III Potassium Channel Blocker

Antidysrhythmic Class III Potassium Channel Blocker e r e h d l o F

Delays repolarization Reduces automaticity in the SAnode, reduces contractility Decreases conduction velocity in the AV AV node, ventricles, and His-Purkinje system

Uses Recurrent ventricular fibrillation Unstable ventricular tachycardia

Adverse Effects Widening of the QRS complex Prolongation of the PR and QT intervals Pulmonary toxicities, sinus bradycardia, AV AV block, hypotension Corneal microdeposits, optic neuropathy Hepatitis, thyroid dysfunction Toxicities in pregnancy Grapefruit juice increases levels to toxicity


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VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM)

VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM) Antidysrhythmics Class IV Calcium Channel Blockers

Antidysrhythmics Class IV Calcium Channel Blockers e r e h d l o F

Block calcium channels in the heart Slow SA node automaticity, automaticity, delay AV AV nodal conduction Reduce myocardial contractility

Uses Atrial fibrillation or atrial flutter Supraventricular tachycardia

Adverse Effects


Bradycardia, AV block, and heart failure Hypotension, peripheral edema, and constipation Can elevate digoxin levels

PROCAINAMIDE PROCAINAMID E (PRONESTYL)

PROCAINAMIDE (PRONESTYL) Antidysrhythmic Class IA Sodium Channel Blocker

Antidysrhythmic Class IA Sodium Channel Blocker e r e h d l o F

Blocks cardiac sodium channels Slows conduction in the atria, ventricles, and His-Purkinje system Delays depolarization

Uses Atrial and ventricular dysrhythmias

Adverse Effects Systemic lupus erythematous–like syndrome Blood dyscrasias QRS widening and prolongation


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LIDOCAINE (XYLOCAINE)

LIDOCAINE (XYLOCAINE) Antidysrhythmic Class IB Sodium Channel Blocker

Antidysrhythmic Class IB Sodium Channel Blocker e r e h d l o F

Blocks cardiac sodium channels Slows conduction in the atria, ventricles, and His-Purkinje system Reduces automaticity in the ventricles and His-Purkinje system Accelerates repolarization

Uses Short-term therapy for ventricular dysrhythmias

Adverse Effects No significant impact on the ECG Drowsiness, confusion, and paresthesias Toxic doses may produce convulsions and respiratory arrest Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

PROPRANOLOL (INDERAL) Antidysrhythmic Class II Beta Blocker

PROPRANOLOL (INDERAL) Antidysrhythmic Class II Beta Blocker e r e h d l o F

Beta-adrenergic antagonist Blocks both beta 1 and beta2 receptors Decreases automaticity of the SA node Decreases velocity of conduction through the AV AV node Decreases myocardial contractility

Uses Sinus tachycardia, severe recurrent ventricular tachycardia Paroxysmal atrial tachycardia, hypertension

Adverse Effects


Prolongs PR interval on the ECG Bradycardia, heart failure, AV AV block, and sinus arrest Bronchospasm in patients with asthma

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ATORVASTATIN (LIPITOR) FLUVASTA FLUVAST ATIN (LESCOL) LOVASTATIN (MEVACOR) PRAVASTATIN (PRAVACHOL) SIMVASTATIN SIMVAST ATIN (ZOCOR) (Z OCOR) ROSUVASTATIN ROSUVAST ATIN (CRESTOR) (CRE STOR)

ATORVASTATIN (LIPITOR) Lipid-Lowering Drug HMG-CoA Reductase Inhibitor (Statin)

Lipid-Lowering Drugs HMG-CoA Reductase Inhibitors (Statins)

e r e h d l o F

Inhibits the enzyme that synthesizes cholesterol Increases the number of LDL receptors to remove LDL Slows progression of CHD, stabilizes plaque

Uses Hypercholesterolemia Primary prevention of CHD

Adverse Effects


Hepatotoxicity, increases ALT and AST Hepatotoxicity, Myopathy,, increases CK levels, rhabdomyolysis, dark urine, renal failure Myopathy Pregnancy Risk Category X Headache, rash, GI complaints Cyclosporine, macrolide antibiotics, antibiotics, azole antifungals, and HIV protease

NICOTINIC ACID (NIACIN)

NICOTINIC ACID (NIACIN) Lipid-Lowering Agent

Lipid-Lowering Agent

Reduces LDL and triglycerides triglycerides Increases HDL e r e h d l o F

Uses Dyslipidemia

Adverse Effects Hepatotoxicity Flushing, itching Gastric upset, nausea, vomiting, diarrhea May raise blood sugar in patients with diabetes May increase incidence of gout


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CHOLESTYRAMINE (QUESTRAN) COLESEVELAM (WELCHOL)

CHOLESTYRAMINE (QUESTRAN) Bile-Acid Sequestrant

Bile-Acid Sequestrants

Forms insoluble complex with bile acids Increases Increa ses LDL recept receptors ors Safest of all lipid-lowering drugs e r e h d l o F

Uses Hypercholesterolemia Often used in combination with statin

Adverse Effects Constipation, bloating, indigestion Reduces uptake of fat-soluble vitamins Interferes with absorption of other drugs


GEMFIBROZIL (LOPID) FENOFIBRATE (TRICOR)

GEMFIBROZIL (LOPID) Fibric Acid Derivative (Fibrate)

Fibric Acid Derivatives (Fibrates)

Decreases triglycerides by lowering VLDL Raises HDLlevels e r e h d l o F

Uses Hypertriglyceridemia

Adverse Effects Myopathy, liver injury Myopathy, Rash, nausea, abdominal pain, diarrhea Gallstone formation Increases warfarin levels, leading to hemorrhage


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EZETIMIBE (ZETIA)

EZETIMIBE (ZETIA) Cholesterol-Lowering Drug Cholesterol-Lowering

Cholesterol-Lowering Cholesterol -Lowering Drug

Blocks cholesterol absorption in the small intestine



Hypercholesterolemia Used in combination with statins

Adverse Effects May increase risk of liver damage when used with statin May increase risk of gallstone formation

NITROGLYCERINE

NITROGLYCERINE Organic Nitrate

Organic Nitrate

Dilates veins, decreases venous return to the heart Decreases preload Decreases cardiac oxygen demand e r e h d l o F

Uses Angina, myocardial infarction

Adverse Effects Headache, orthostatic hypotension Reflex tachycardia Use with sildenafil (Viagra), other drugs for erectile dysfunction may lead to severe hypotension


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CLOPIDOGREL (PLAVIX)

CLOPIDOGREL (PLAVIX) Adenosine Diphosphate–Receptor Antagonist ADP Receptor Blocker Antiplatelet Drug

Adenosine Diphosphate–Receptor Antagonist ADP Receptor Blocker Antiplatelet Drug

Blocks enzyme so that platelets are unable to a ggregate e r e h d l o F


Uses Prevention of stroke and MI

Adverse Effects Hemorrhage

EPTIFIBATIDE (INTEGRILIN)

EPTIFIBATIDE (INTEGRILIN) Glycoprotein llb/llla–Recepto Glycoprotein llb/llla–Receptorr Antagonists Antiplatelet Drug—”Super Aspirin”

Glycoprotein llb/llla–Recep Glycoprotein llb/llla–Receptor tor Antagonists Antiplatelet Drug—”Super Aspirin”

Interferes with the final step in platelet aggregation e r e h d l o F

Uses Acute coronary syndrome Used during angioplasty

Adverse Effects Intercranial hemorrhage, gastrointestinal bleeding Hematuria, gingival bleeding Thrombocytopenia Anaphylaxis


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ALTEPLASE (tPA)

ALTEPLASE AL TEPLASE (tPA) Thrombolytic Drug

Thrombolytic Drug

Converts plasminogen to plasmin Plasmin is an enzyme that digests the fibrin matrix of clots e r e h d l o F


Uses Acute myocardial infarction, pulmonary embolism, and ischemic stroke

Adverse Effects Bleeding Intracranial hemorrhage

HEPARIN

HEPARIN Parenteral Anticoagulant

Parenteral Anticoagulant

Suppresses the formation of fibrin in veins Inactivates clotting factors thrombin and Xa Anticoagulant effect develops quickly e r e h d l o F

Uses Prevents venous thrombosis Used for pulmonary embolism, evolving stroke, DVT Open heart surgery, MI, renal dialysis

Monitoring Activated partial thromboplastin time (aPTT) Normal aPTT 40 seconds; therapeutic level 60 to 80 seconds seconds

Adverse Effects Bleeding—antidote is protamine sulfate Heparin-induced thrombocytopenia (HIT) (Decreased platelet count 100,000 leads to thrombosis) May be used during pregnancy


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WARFARIN (COUMADIN)

WARFARIN (COUMADIN) Oral Anticoagulant

Oral Anticoagulant

Suppresses coagulation by antagonizing vitamin K Blocks synthesis of factors VII, IX, X, and prothrombin Effect takes a few days e r e h d l o F

Uses Long-term prophylaxis of venous thrombosis Used in patients with mechanical heart valves Used in patients with atrial fibrillation

Monitoring Prothrombin time (PT)—reported as INR Goal INR for atrial fibrillation is 2–3 Goal INR for mechanical valves is 3–4.5


FERROUS SULFATE

FERROUS SULFATE Oral Iron Preparation

Oral Iron Preparation Uses Iron deficiency anemia (microcytic hypochromic anemia) e r e h d l o F

Adverse Effects Nausea, heartburn, bloating, constipation, diarrhea Liquid iron preparation stains teeth Toxic to children (lethal dose is 2 to 10 grams)


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CYANOCOBALAMIN (VITAMIN B 12)

CYANOCOBALAMIN (VITAMIN B 12) Essential for synthesis of DNA Catalyzes conversion of folic acid to its active form



B12 deficiency, pernicious anemia Macrocytic normochromic anemia (megaloblastic anemia)

Adverse Effects Hypokalemia

FOLIC ACID (FOLATE)

FOLIC ACID (FOLATE) Essential for synthesis of DNA

Uses Treatment of folic acid deficiency (megaloblastic anemia) Used prophylactically to prevent neural tube defects (NTDs) e r e h d l o F

Adverse Effects Folic acid does not correct neurologic consequences Will correct anemia, but may mask B12 deficiency Always give folic acid with B12


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OPRELVEKIN (INTERLEUKIN-11)

OPRELVEKIN (INTERLEUKIN-11) Thrombopoietic Growth Factor

Thrombopoietic Growth Factor

Stimulates production of platelets (thrombocytes)



Used in patients undergoing chemotherapy to increase platelets

Adverse Effects Retention of sodium and water by kidney Peripheral edema Anemia, dyspnea, tachycardia

EPOETIN ALFA (ERYTHROPOIETIN)

EPOETIN ALFA (ERYTHROPOIETIN) Hematopoietic Growth Factor

Hematopoietic Growth Factor

Stimulates production of red blood cells


Anemia of chronic renal failure Anemia due to AIDS treatment with with AZT (zidovudine) Anemia caused by chemotherapy

Adverse Effects Hypertension Increase in cardiovascular events Red cell aplasia


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FILGRASTIM (NEUPOGEN)

FILGRASTIM (NEUPOGEN) Granulocyte Colony Stimulating Factor (G-CSF)

Granulocyte Colony Stimulating Factor (G-CSF)

Acts on bone marrow to increase production of neutrophils



Used in patients undergoing chemotherapy Decreases risk of infection

Adverse Effects Bone pain, leukocytosis Elevates uric acid levels, LDH, and alkaline phosphatase Splenomegaly

GLIPIZIDE (GLUCOTROL) GLYBURIDE (MICRONASE) GLIMEPIRIDE (AMARYL)

GLIPIZIDE (GLUCOTROL) Oral Hypoglycemic Agent Sulfonylurea

Oral Hypoglycemic Agents Sulfonylureas

Stimulates insulin release from the pancreas e r e h d l o F

Uses Type 2 diabetes

Adverse Effects Hypoglycemia Fetal harm


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METFORMIN (GLUCOPHAGE)

METFORMIN (GLUCOPHAGE) Oral Hypoglycemic Agent Biguanide

Oral Hypoglycemic Agent Biguanide

Decreases blood sugar by decreasing production of glucose in the liver Enhances glucose uptake and utilization in muscle e r e h d l o F



Adverse Effects Decreased appetite, nausea, diarrhea, and we ight loss Lactic acidosis Avoid Avoi d in patients with renal or liver disease Avoid Avoi d in patients with ETOH abuse, infection, or CHF Discontinue 48 hours prior to test with contrast media to avoid lactic acidosis

ROSIGLITAZONE (AVANDIA) PIOGLITAZONE (ACTOS) Thiazolidinediones (TZDs) Thiazolidinediones “Glitazones” Insulin Sensitizers

ROSIGLITAZONE (AVANDIA) Thiazolidinedione Thiazolidinedion e (TZD) “Glitazone” Insulin Sensitizer Increases insulin sensitivity e r e h d l o F


Adverse Effects Fluid retention—caution in patients with CHF Hepatotoxicity—monitorr AL Hepatotoxicity—monito ALT T


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MIGLITOL (GLYSET) ACARBOSE (PRECOSE)

MIGLITOL (GLYSET) ACARBOSE (PRECOSE) Alpha-Glucosidase Alpha-Glucos idase Inhibitors Hypoglycemic Agent

Alpha-Glucosidase Inhibitors Alpha-Glucosidase Hypoglycemic Agents e r e h d l o F

Delay absorption of carbohydrates Lower postprandial blood glucose levels


Adverse Effects Flatulence, cramps, abdominal distention, diarrhea Hypoglycemia, liver dysfunction


REPAGLINIDE (PRANDIN) NATEGLINIDE (STARLIX)

REPAGLINIDE (PRANDIN) NATEGLINIDE (STARLIX) Meglitinides Hypoglycemic Agents

Meglitinides Hypoglycemic Agents

Stimulate pancreatic insulin release e r e h d l o F


Adverse Effects Hypoglycemia Administer 30 minutes before meal


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GLUCAGON

GLUCAGON Hormone that increases plasma levels of glucose Opposite effect of insulin



Treats hypoglycemia from insulin overdose Used only if IV glucose is not available

LEVOTHYROXINE LEVOTHYROXIN E (SYNTHROID, LEVOXYL)

LEVOTHYROXINE (SYNTHROID, LEVOXYL) Thyroid Replacement Hormone Synthetic Preparation of T 4

Thyroid Replacement Hormone Synthetic Preparation of T 4

Converted to T3 in the body Thyroid hormone replacement e r e h d l o F

Uses Hypothyroidism

Adverse Effects Thyrotoxicosis if dosage is excessive Tachycardia, angina, nervousness, insomnia Hyperthermia, sweating, and tremor Increases warfarin levels Takes about 1 month to reach plateau


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PROPYLTHIOURACIL (PTU)

PROPYLTHIOURACIL (PTU) Antithyroid Drug

Antithyroid Drug

Inhibits thyroid hormone synthesis



Hyperthyroidism, Graves’ disease Thyrotoxic crisis

Adverse Effects Agranulocytosis, hypothyroidism, rash Fetal harm

GLUCOCORTICOIDS

GLUCOCORTICOIDS Suppress immune responses and inflammation Inhibit prostaglandins, leukotrienes, and histamine Suppress phagocytes and lymphocytes


Rheumatoid arthritis, SLE, inflammatory bowel disease Bursitis, osteoarthritis, anaphylaxis, asthma Skin disorders, prevention of respiratory distress syndrome (RDS) in preterm infants Replacement therapy for patients with Addison’s disease

Adverse Effects Adrenal insufficiency resulting from suppression of HPA HPA axis Glucose intolerance (increases blood sugar), osteoporosis, infection Growth retardation, mood changes, cataracts, glaucoma Peptic ulcer disease, iatrogenic Cushing’s syndrome


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SILDENAFIL (VIAGRA) TADALAFIL (CIALIS) VARDENAFIL (LEVITRA)

SILDENAFIL (VIAGRA) Erectile Dysfunction Drug Enhances the normal erectile response to sexual stimuli by inhibiting PDE-5

Erectile Dysfunction Drugs e r e h d l o F


Uses Erectile dysfunction

Adverse Effects Hypotension, priapism, headache, and flushing Visual changes Use with nitrates and alpha blockers leads to hypotension

PRAZOSIN (MINIPRESS)

PRAZOSIN (MINIPRESS) Alpha-Adrenergic Antagonist Alpha-Adrenergic Alpha Blocker

Alpha-Adrenergic Antagonist Alpha Blocker e r e h d l o F

Blocks alpha1 receptors Dilates arteries and veins Relaxes smooth muscle in the bladder neck and prostatic capsule

Uses Benign prostatic hypertrophy Hypertension

Adverse Effects Orthostatic hypotension, reflex tachycardia Inhibition of ejaculation Nasal congestion Use with erectile dysfunction drugs may lead to hypotension Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

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LIVE VIRUS VACCINES

LIVE VIRUS VACCINES

Varicella (Varivax) Oral Polio Vaccine (OPV) not used in the United States Measles, Mumps, and Rubella Virus Vaccine (MMR) Live Influenza Attenuated Vaccine (LIAV)

Live virus vaccines are contraindicated in pregnancy Give with caution in immunocompro immunocompromised mised patients

e r e h d l o F


CYCLOSPORINE (SANDIMMUNE (SANDIMMUNE))

CYCLOSPORINE (SANDIMMUNE) Immunosuppressant Drug

Immunosuppressant Immunosuppr essant Drug

Suppresses production of inflammatory cells Decreases B cells and cytotoxic T cells e r e h d l o F

Uses Organ transplant

Adverse Effects Nephrotoxicity, infection, hepatotoxicity, lymphomas Nephrotoxicity, Hypertension, anaphylaxis, fetal harm


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METHOTREXATE (RHEUMATREX, TREXALL)

METHOTREXATE (RHEUMATREX, TREXALL) Cytotoxic Drug Immunosuppressant Disease-Modifying Disease-Mod ifying Antirheumatic Drug (DMARD)

Cytotoxic Drug Immunosuppressant Disease-Modifying Disease-Modif ying Antirheumatic Drug (DMARD) e r e h d l o F

Blocks conversion of folic acid to its active form Reduces joint destruction, retards disease progression Takes 3 to 5 months to see effect

Uses Rheumatoid arthritis, non-Hodgkin’ non-Hodgkin’ss lymphoma Lymphocytic Lympho cytic leukemia, psoriasis

Adverse Effects Bone marrow suppression, hepatic fibrosis GI ulceration, pneumonitis, and fetal harm Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

DIPHENHYDRAMINE (BENADRYL)

DIPHENHYDRAMINE (BENADRYL) First-Generation First-Generatio n H 1 Antagonist Antihistamine

First-Generation H1 Antagonist First-Generation Antihistamine e r e h d l o F

Blocks H1 receptors Blocks some muscarinic receptors Reduces actions of histamine Decreases flushing, itching, and secretion of mucus

Uses Allergic rhinitis, urticaria, motion sickness, insomnia Cold symptoms, mild transfusion reactions, allergic reac tions

Adverse Effects Sedation, confusion, nausea, and dry throat


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LORATADINE (CLARITIN) DESLORATADINE (CLARINEX) FEXOFENADINE (ALLEGRA) CETIRIZINE (ZYRTEC)

LORATADINE (CLARITIN) Second-Generation Nonsedating H 1 Second-Generation Antagonist (Antihistamin (Antihistamine) e)

Second-Generation Nonsedating H 1 Second-Generation Antagonists (Antihistamine (Antihistamines) s)

e r e h d l o F

Blocks H1 receptors Reduces actions of histamine Decreases flushing, itching, secretion of mucus Does not cross blood-brain barrier to cause sedation

Uses Allergic rhinitis, urticaria, and mild transfusion reactions

Adverse Effects Decrease dose if hepatic or renal impairment occurs Cetirizine (Zyrtec) may cause mild sedation in some patients


ASPIRIN

ASPIRIN Antiplatelet Drug Cyclooxygenase Cyclooxygenas e (COX) Inhibitor First-Generation NSAID

Antiplatelet Drug Cyclooxygenase (COX) Inhibitor First-Generation First-Generati on NSAID e r e h d l o F

Suppresses platelet aggregation by inhibiting COX-1 and COX-2 Decreases prostaglandin synthesis Reduces inflammation, pain, and fever

Uses Pain, fever, inflammation Prevention of thrombus in arteries Prevents MI and stroke


Bleeding, gastric ulceration, renal impairment Not used in children because of Reye’s syndrome Fetal harm, salicylism Hypersensitivity in patients with allergies

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IBUPROFEN (ADVIL, MOTRIN)

IBUPROFEN (ADVIL, MOTRIN) First-Generation NSAID

First-Generation First-Generati on NSAID

Inhibits cyclooxygenase (COX)-1 and COX-2 Inhibits prostaglandin synthesis Has antiinflammatory, analgesic, and antipyretic actions e r e h d l o F


Uses Dysmenorrhea, arthritis, pain, and fever

Adverse Effects Bleeding, gastric ulceration, renal impairment Cross-hypersensitivity with aspirin May precipitate Reye’s syndrome, fetal harm

CELECOXIB (CELEBREX)

CELECOXIB (CELEBREX) Second-Generation NSAID Second-Generation COX-2 Inhibitor

Second-Generation NSAID Second-Generation COX-2 Inhibitor e r e h d l o F

Selective inhibition of COX-2, decreases prostaglandin synthesis (pain and inflammation reduced) Spares COX-1 inhibition Minimal gastric, renal, and platelet effect

Uses Osteoarthritis, rheumatoid arthritis, dysmenorrhea Acute pain

Adverse Effects Dyspepsia, mild renal impairment Not used in patients with sulfonamide allergy Premature closure of ductus arteriosus Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

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ACETAMINOPHEN (TYLENOL)

ACETAMINOPHEN (TYLENOL) Analgesic Antipyretic

Analgesic Antipyretic

Decreases prostaglandin synthesis in the CNS Devoid of antiinflammatory properties e r e h d l o F

Uses Pain and fever Preferred in children No GI injury, no effect on platelets or kidneys

Adverse Effects Toxic Tox ic metabolite builds up in ETOH abusers Hepatic necrosis can occur Acetylcysteine (Mucomyst) given for overdose Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

FLUTICASONE PROPIONATE (FLOVENT)

FLUTICASONE PROPIONATE (FLOVENT) Inhaled Corticosteroid (ICS)

Inhaled Corticosteroid (ICS)

e r e h d l o F

Suppresses inflammation Decreases leukotrienes, histamine, and prostaglandins Decreases eosinophils and leukocytes Reduces edema of airway and mucous production Reduces bronchial hyperactivity Increases number and responsiveness of beta2 receptors

Uses Asthma

Adverse Effects


Oropharyngeal candidiasis—rinse mouth after use Minimal adrenal suppression and bone loss Slows growth but does not reduce adult height Slight increased risk of cataracts and glaucoma

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SALMETEROL (SEREVENT)

SALMETEROL (SEREVENT) Long-Acting Inhaled Beta 2-Adrenergic Agonist

Long-Acting Inhaled Beta 2-Adrenergic Agonist

e r e h d l o F

Activates beta2 receptors in the lung Promotes bronchodilation Suppresses histamine release in the lung Increases ciliary motility

Uses Asthma

Adverse Effects Effect is delayed by 20 to 30 minutes Not to be used as a rescue inhaler in an emergency Tachycardia, angina, tremor, and leg cramps


MONTELUKAST MONTELUKAS T (SINGULAIR)

MONTELUKAST (SINGULAIR) Leukotriene Modifier

Leukotriene Modifier

e r e h d l o F

Blocks leukotriene receptors Decreases inflammation, bronchoconstriction, and edema Decreases mucous secretion Decreases eosinophils and other inflammatory cells Reduces dosage of inhaled corticosteroid (ICS)

Uses Asthma and allergic rhinitis

Adverse Effects GI upset Effect is delayed


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THEOPHYLLINE

THEOPHYLLINE Methylxanthine Bronchodilator

Methylxanthine Bronchodilator

Produces bronchodilation by relaxing bronchi e r e h d l o F


Uses Asthma (beta2 agonists and corticosteroids preferred)

Adverse Effects Narrow therapeutic range (5 to 10 mcg/mL) Dysrhythmias, ventricular fibrillation Convulsions, cardiorespiratory collapse, and death

ALBUTEROL (PROVENTIL, VENTOLIN, ACCUNEB)

ALBUTEROL (PROVENTIL, VENTOLIN, ACCUNEB) Beta2-Adrenergic Agonist Bronchodilator

Beta2-Adrenergic Agonist Bronchodilator e r e h d l o F

Stimulates beta2 receptors in the lung Bronchodilation Rapid onset of action for rescue breathing

Uses Asthma

Adverse Effects Hyperglycemia, tachycardia, tremor


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RANITIDINE (ZANTAC) CIMETIDINE (TAGAMET) FAMOTIDINE (PEPCID) NIZATIDINE (AXID)

RANITIDINE (ZANTAC) Histamine2-Receptor Antagonist

Histamine2-Receptor Antagonists

Blocks H2 receptors on parietal cells of the stomach Reduces volume of gastric juice and hydrogen ion content e r e h d l o F

Uses Gastric and duodenal ulcers Gastroesophageal reflux disease (GERD), dyspepsia Treatment of Zollinger-Ellison syndrome

Adverse Effects Significant side effects are uncommon


OMEPRAZOLE (PRILOSEC) LANSOPRAZOLE (PREVACID) RABEPRAZOLE (ACIPHEX) PANTOPRAZOLE (PROTONIX) ESOMEPRAZOLE (NEXIUM) Proton Pump Inhibitors (PPIs)

OMEPRAZOLE (PRILOSEC) Proton Pump Inhibitor (PPI) Inhibits the enzyme that generates acid production


Duodenal and gastric ulcers, GERD, dyspepsia Zollinger-Ellison syndrome

Adverse Effects Headache, diarrhea, nausea, and vomiting


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SUCRALFATE (CARAFATE)

SUCRALFATE (CARAFA (CAR AFATE) TE) Antiulcer drug

Antiulcer drug

Creates a protective barrier against acid and pepsin Sticky gel adheres to ulcer crater e r e h d l o F


Uses Duodenal and gastric ulcers

Adverse Effects May impede the absorption of some drugs Separate at least 2 hours from other drugs

METOCLOPRAMIDE (REGLAN)

METOCLOPRAMIDE (REGLAN) Prokinetic Drug

Prokinetic Drug

Reduces emesis by blocking receptors in the chemoreceptor trigger zone (CTZ) Increases upper GI motility by enhancing the actions of ACh e r e h d l o F

Uses Suppresses nausea caused by chemotherapy Suppresses postoperative emesis and GERD

Adverse Effects Sedation and diarrhea Extrapyramidal reactions, especially in children


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SULFASALAZINE (AZULFIDINE)

SULFASALAZINE (AZULFIDINE) Aminosalicylate

Aminosalicylate

Reduces inflammation



Inflammatory bowel disease Crohn’s disease and ulcerative colitis

Adverse Effects Nausea, fever, rash, and arthralgias Agranulocytosis, hemolytic anemia, and macrocytic anemia

ONDANSETRON (ZOFRAN)

ONDANSETRON (ZOFRAN) Antiemetic Drug Serotonin-Receptor SerotoninReceptor Antagonist

Antiemetic Drug Serotonin-Receptor Antagonist Serotonin-Receptor

Suppresses emesis by blocking 5-HT 3 receptors in the chemoreceptor trigger zone (CTZ) e r e h d l o F

Uses Decreases nausea and vomiting due to: Chemotherapy,, radiation therapy, and anesthesia (postoperatively) Chemotherapy

Adverse Effects Headache, nausea, and dizziness


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PROCHLORPERAZINE (COMPAZINE) PROMETHAZINE (PHENERGAN)

PROCHLORPERAZINE (COMPAZINE) Antiemetic Drug Dopamine Antagonist

Antiemetic Drugs Dopamine Antagonists

Suppresses emesis by blocking dopamine 2 receptors in the CTZ e r e h d l o F


Uses Nausea and vomiting Used after surgery, cancer chemotherapy, or other conditions

Adverse Effects Extrapyramidal reactions, anticholinergic effects Hypotension and sedation

HYDROXYZINE (VISTARIL, ATARAX)

HYDROXYZINE (VISTARIL, ATARAX) Antiemetic Drug Anticholinergic-Antihistamine

Antiemetic Drug Anticholinergic-Antihistamine

Blocks histaminergic and cholinergic receptors e r e h d l o F

Uses Nausea

Adverse Effects Sedation, blurry vision, urinary retention, dry mouth


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PENICILLIN G (BENZYLPENICIL (BENZYLPENICILLIN) LIN)

PENICILLIN G (BENZYLPENICI (BENZYLPENICILLIN) LLIN) Narrow-Spectrum Narrow-Sp ectrum Penicillin

Narrow-Spectrum Narrow-Spe ctrum Penicillin

Weakens the bacterial cell wall



Treats Streptococcus, Neisseria, anaerobes, and others Drug of choice for syphilis

Adverse Effects Allergic reaction, pain at site of injection Neurotoxicities

NAFCILLIN (UNIPEN)

NAFCILLIN (UNIPEN) Penicillinase-Resistant Penicillin Penicillinase-Resistant (Antistaphylococcal (Antistaphylo coccal Penicillin)

Penicillinase-Resistant Penicillin Penicillinase-Resistant (Antistaphylococcal (Antistaphyloc occal Penicillin)

Weakens the cell wall e r e h d l o F

Uses Treats infections caused by Staphylococcus aureus

Adverse Effects Allergic reaction, GI effects Thrombophlebitis, hypokalemia Thrombophlebitis,


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AMOXICILLIN (AMOXIL)

AMOXICILLIN (AMOXIL) Broad-Spectrum Penicillin (Aminopenicillin) Broad-Spectrum

Broad-Spectrum Broad-Spect rum Penicillin (Aminopenici (Aminopenicillin) llin)




Treats infections caused by Haemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci Neisseria gonorrhoeae

Adverse Effects Diarrhea

CEFAZOLIN (KEFZOL, ANCEF)

CEFAZOLIN (KEFZOL, ANCEF) First-Generation Cephalosporin First-Generation Beta-Lactam Antibiotic

First-Generation Cephalosporin First-Generation Beta-Lactam Antibiotic


Uses

e r e h

Gram-positive infections Surgical prophylaxis

d l o F

Adverse Effects Allergic reaction Bleeding tendencies Thrombophlebitis Antibiotic-associated pseudomembranous colitis (AAPMC)


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CEFUROXIME (CEFTIN)

CEFUROXIME (CEFTIN) Second-Generation Cephalosporin Second-Generation Beta-Lactam Antibiotic

Second-Generation Cephalosporin Second-Generation Beta-Lactam Antibiotic



Uses

e r e h

Upper respiratory tract infections Acute otitis media (AOM) and sinusitis

d l o F


CEFTRIAXONE (ROCEPHIN)

CEFTRIAXONE (ROCEPHIN) Third-Generation Cephalosporin Third-Generation Beta-Lactam Antibiotic

Third-Generation Cephalosporin Third-Generation Beta-Lactam Antibiotic

Weakens the bacterial cell wall e r e h d l o F

Uses Active against gram-negative organisms



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VANCOMYCIN (VANCOCIN)

VANCOMYCIN (VANCOCIN) Antibiotic

Antibiotic

Inhibits bacterial cell wall synthesis


Active against gram-positive bacteria Serious infections, such as methicillin-resistant Staphylococcus aureus (MRSA) Antibiotic-associated pseudomembranous colitis (AAPMC) Used for patients allergic to penicillin

Adverse Effects


Ototoxicity Rapid infusion can lead to “red man syndrome” (flushing, tachycardia, and hypotension) Infuse over 60 minutes or more Thrombophlebitis

TETRACYCLINE DOXYCYCLINE MINOCYCLINE

TETRACYCLINE Broad-Spectrum Antibiotic Broad-Spectrum Suppresses bacterial growth by inhibiting protein synthesis

Broad-Spectrum Broad-Spect rum Antibiotics


Rocky Mountain spotted fever, typhus Chlamydia trachomatis, Mycoplasma pneumonia Helicobacter pylori, anthrax, and Lyme disease Acne, peptic ulcer disease, periodontal disease

Adverse Effects GI irritation, suprainfection (AAPMC) Discoloration of teeth (avoid in children 8 years old) Hepatotoxicity,, exacerbation of renal impairment Hepatotoxicity Photosensitivity,, vestibular toxicity Photosensitivity


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ERYTHROMYCIN CLARITHROMYCIN (BIAXIN) AZITHROMYCIN (ZITHROMAX) DIRITHROMYCIN (DYNABAC) TELITHROMYCIN TELITHROMYC IN (KETEK)

ERYTHROMYCIN Macrolide Antibiotic Broad-Spectrum Broad-Spe ctrum Antibiotic

Macrolide Antibiotics Broad-Spectrum Broad-Spect rum Antibiotics

Inhibits bacterial cell wall synthesis e r e h d l o F

Uses Active against most gram-positive and some gram-negative organisms Treats atypicals such as Legionella pneumonia, pertussis, diphtheria, and pneumonia caused by Mycoplasma pneumoniae Can be used as an alternative to PCN in allergic individuals

Adverse Effects GI effects, liver injury Inhibitor of cytochrome P450 Increases levels of theophylline, carbamazepine, and some statins Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

CLINDAMYCIN (CLEOCIN)

CLINDAMYCIN (CLEOCIN) Antibiotic

Antibiotic

Inhibits bacterial protein synthesis


Active against most anaerobic bacteria outside the CNS Bacteroides fragilis, Fusobacterium, Clostridium perfringens

Adverse Effects Antibiotic-associated pseudomembranous colitis (AAPMC) Diarrhea


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GENTAMICIN (GARAMYCIN) AMIKACIN (AMIKIN) TOBRAMYCIN (NEBCIN)

GENTAMICIN (GARAMYCIN) Aminoglycoside Aminoglycosid e Antibiotic Narrow-Spectrum Narrow-Spe ctrum Antibiotic

Aminoglycoside Antibiotics Aminoglycoside Narrow-Spectrum Narrow-Spec trum Antibiotics

Disrupts bacterial protein synthesis e r e h d l o F


Uses Effective against aerobic gram-negative bacilli

Adverse Effects Nephrotoxicity (renal dosing required to avoid toxic drug levels) Ototoxicity (requires peak and trough level monitoring) Intensifies neuromuscular blockade, leading to respiratory arrest Incompatible with PCN

TRIMETHOPRIM/SULFAMETHOXAZOLE (TMP-SMZ-BACTRIM)

TRIMETHOPRIM/SULFAMETHOXAZOLE (TMP-SMZ-BACTRIM) Antibiotic

Antibiotic

Combination antibiotic that inhibits bacterial synthesis of folic acid e r e h d l o F

Uses Urinary tract infections Pneumonia caused by Pneumocystis carinii

Adverse Effects Nausea, vomiting, rash, blood dyscrasias Hypersensitivity reactions (Stevens-Johnson syndrome) Not for use in patients with sulfa allergies Avoid use in pregnant women near term Avoid use in infants under the age of 2 months


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CIPROFLOXACIN CIPROFLOXAC IN (CIPRO) MOXIFLOXACIN (AVELOX) GATIFLOXACIN (TEQUIN) LEVOFLOXACIN (LEVAQUIN)

CIPROFLOXACIN CIPROFLOXAC IN (CIPRO) Fluoroquinolone Antibiotic Fluoroquinolone

Fluoroquinolone Fluoroquino lone Antibiotics

Inhibits bacterial DNA



Infections of the urinary, respiratory, and GI tracts; bones; joints; skin; and soft tissues

Adverse Effects GI upset, CNS effects (dizziness, headache, restlessness) Achilles tendon rupture Do not take with milk products Elevates levels of warfarin Not recommended for children under 18 years old Avoid in pregnancy

METRONIDAZOLE METRONIDAZO LE (FLAGYL)

METRONIDAZOLE (FLAGYL) METRONIDAZOLE Antibacterial Drug

Antibacterial Drug

Causes cell death by damaging bacterial DNA


Protozoal infection Infections caused by obligate anaerobic bacteria Bacteroides, Clostridium difficile, Helicobacter pylori, Trichomonas vaginalis, giardiasis Used as prophylaxis in colorectal or abdominal surgery

Adverse Effects Nausea, headache, dry mouth, metallic taste Dark discoloration of urine Disulfiram-like effect when used with alcohol Increases warfarin levels Copyright © 2007 by Saunders, an imprint of Elsevier Elsevier Inc.

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KETOCONAZOLE (NIZORAL) FLUCONAZOLE (DIFLUCAN) ITRACONAZOLE (SPORANOX) MICONAZOLE (MONISTAT) CLOTRIMAZOLE

KETOCONAZOLE (NIZORAL) KETOCONAZOLE Antifungal Agent

Antifungal Agents

Causes bacterial cell wall to leak



Systemic and superficial mycoses (fungi)

Adverse Effects Hepatotoxicity (monitor liver function tests [LFTs]) Decreases sex hormones Don’t give with PPIs Inhibits hepatic drug-metabolizing enzymes Increases levels of warfarin, phenytoin, and some statins

GRISEOFULVIN

GRISEOFULVIN Antifungal Agent

Antifungal Agent

Inhibits fungal mitosis


Superficial mycoses (fungi) Dermatophytic infections of the skin, hair, and nails Not active against Candida species or systemic mycoses May take 3 to 8 weeks to respond

Adverse Effects May decrease the effects of warfarin


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ACYCLOVIR (ZOVIRAX) VALACYCLOVIR (VAL (VALTREX) TREX) FAMCICLOVIR (FAMVIR)

ACYCLOVIR (ZOVIRAX) Antiviral Agent Suppresses synthesis of viral DNA

Antiviral Agents



Herpesvirus, varicella-zoster virus, cytomegalovirus (CMV)

Adverse Effects IV administration can lead to phlebitis and nephrotoxicity nephrotoxicity Infuse slowly over 1 hour and maintain hydration Oral therapy may lead to nausea, vomiting, diarrhea Headache and vertigo

INTERFERON ALPHA

INTERFERON ALPHA Antiviral Agent

Antiviral Agent

Decreases viral replication


Hepatitis B and C

Adverse Effects Flulike syndrome Depression Fatigue, hair loss, thyroid damage, heart damage Bone marrow suppression


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RIBAVIRIN (REBETOL)

RIBAVIRIN (REBETOL) Antiviral Agent

Antiviral Agent Uses Used with interferon for treatment of hepatitis C e r e h d l o F


Adverse Effects Hemolytic anemia Fetal harm (Category X) Use second reliable form of birth control during treatment and 6 months after treatment

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs) Zidovudine (Retrovir) Lamivudine (Epivir) Zalcitabine (Hivid) Antiretroviral Antiretro viral Drugs

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs) Antiretroviral Drugs Suppress the synthesis of viral DNA by blocking transcriptase e r e h d l o F

Uses HIV infect infection ion

Adverse Effects Anemia, neutropenia, lactic acidosis


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NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)

NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs) Antiretroviral Drugs

Delavirdine (Rescriptor) Efavirenz (Sustiva) Nevirapine (Viramune)

Antiretroviral Antiretro viral Drugs

Inhibit reverse transcriptase by binding to it e r e h d l o F


Uses HIV infect infection ion

Adverse Effects Rash, Stevens-Johnson syndrome, erythema multiforme Hepatotoxicity

PROTEASE INHIBITORS

PROTEASE INHIBITORS Antiretroviral Drugs

Nelfinavir (Virac (Viracept) ept) Ritonavir (Norvir) Saquinavir (Invirase)

Antiretroviral Antiretro viral Drugs

Inhibit the enzyme enzyme protease, needed for HIV to mature


HIV

Adverse Effects Hyperglycemia, diabetes, fat redistribution, hyperlipidemia Increased bleeding in hemophiliac patients Reduced bone mineral density Elevation of serum transaminases Can increase or decrease levels of other drugs


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