Pharmacology Flash Cards
March 7, 2017 | Author: David Hosam | Category: N/A
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Drug Receptor Types Functions of Peripheral Adrenergic Receptor Subtypes
Functions of Peripheral Cholinergic Receptor Subtypes
Receptor Subtype
Receptor Subtype
Response to Receptor Activation Mydriasis—wide eyed with fear 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 sympathetic nervous system (SNS) outflow to the blood vessels and heart Increased rate, force of contraction, and AV conduction velocity Renin release—RAS Dilation
Nicotinicn
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Location
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 Classification
Drug Example
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 enzyme (ACE) inhibitor Angiotensin-receptor blocker (ARB) Calcium channel blocker Lipid-lowering drug Thrombolytic Anticoagulant Corticosteroid Bisphosphonate for osteoporosis
prazosin metoprolol diazepam, alprazolam lisinopril candesartan amlodipine atorvastatin alteplase enoxaparin prednisone alendronate
-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 antibiotic Tetracycline antibiotic Fluoroquinolone antibiotic Macrolide antibiotic Aminoglycoside antibiotic Antifungal
albuterol cimetidine omeprazole amoxicillin cefazolin tetracycline levofloxacin azithromycin gentamycin itraconazole
Continued Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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Drug Endings
BETHANECHOL (URECHOLINE)
BETHANECHOL (URECHOLINE) Muscarinic Agonist
Muscarinic Agonist
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Activates muscarinic receptors Causes contraction of the detrusor muscle of the bladder
Uses Postoperative urinary retention Adverse Effects Hypotension Bradycardia, dysrhythmias Bronchoconstriction GI effects
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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ATROPINE
ATROPINE Muscarinic Antagonist (Anticholinergic)
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Muscarinic Antagonist (Anticholinergic)
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 Inc.
Blurry vision, urinary retention, dry mouth, constipation, tachycardia Increases intraocular pressure
NEOSTIGMINE (PROSTIGMINE)
NEOSTIGMINE (PROSTIGMINE) Reversible Cholinesterase Inhibitor
Reversible Cholinesterase Inhibitor
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Prevents the degradation of acetylcholine (ACh) Enhances the effect of ACh to stimulate skeletal muscle
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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SUCCINYLCHOLINE
SUCCINYLCHOLINE Depolarizing Neuromuscular Blocker
Depolarizing Neuromuscular Blocker
Causes paralysis of muscle by preventing repolarization
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Uses
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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
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Activates alpha1 receptors Constricts blood vessels of the skin, viscera, and mucous membranes
Uses Treatment of nasal congestion Delay of anesthetic absorption Dilation of the pupil for ocular exam Adverse Effects Hypertension Necrosis
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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EPINEPHRINE
EPINEPHRINE Adrenergic Agonist (Catecholamine)
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Adrenergic Agonist (Catecholamine)
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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 Delays absorption of local anesthetic and controls superficial bleeding Reduces nasal congestion Dilates pupil for eye procedures
Adverse Effects Hypertension, tachycardia, and dysrhythmias Angina, necrosis following extravasation Hyperglycemia in diabetic patients
PROPRANOLOL (INDERAL) Adrenergic Antagonist Noncardioselective Beta Blocker
PROPRANOLOL (INDERAL)
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Adrenergic Antagonist Noncardioselective Beta Blocker
Blocks beta1 and beta2 receptors Reduces heart rate, decreases force of ventricular contraction Decreases conduction through AV node, decreases cardiac output Suppresses renin, bronchoconstriction
Uses Angina, hypertension, cardiac dysrhythmias Myocardial infarction, heart failure, hyperthyroidism, glaucoma
Adverse Effects
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Beta Blocker
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Adrenergic Antagonist Cardioselective Beta Blocker
Blocks cardiac beta1 receptors Reduces heart rate, decreases force of ventricular contraction Decreases conduction through 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
Adverse Effects Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Bradycardia, reduction of cardiac output, AV heart block Rebound cardiac excitation following abrupt withdrawal
PRAZOSIN (MINIPRESS)
PRAZOSIN (MINIPRESS) Adrenergic Antagonist Alpha blocker
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Adrenergic Antagonist Alpha Blocker
Blocks alpha1 receptors Dilates arteries and veins Relaxes smooth muscle in the bladder neck and prostatic capsule
Uses Hypertension Benign prostatic hypertrophy
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Alpha2 Agonist Antihypertensive Drug
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Centrally Acting Alpha2 Agonist Antihypertensive Drug
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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 Fetal harm
LEVODOPA/CARBIDOPA (SINEMET)
LEVODOPA/CARBIDOPA (SINEMET) Dopaminergic Agent
Dopaminergic Agent
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Levodopa increases synthesis of dopamine in the striatum Carbidopa enhances the effect of levodopa
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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DONEPEZIL (ARICEPT)
DONEPEZIL (ARICEPT) Cholinesterase Inhibitor
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Cholinesterase Inhibitor
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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)
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Inhibits entry of sodium into neurons Suppresses action potential of neurons
Uses Epilepsy
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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)
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Blocks sodium channels to suppress neurons Suppresses calcium influx Increases inhibitory influence of gamma-aminobutyric acid (GABA)
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Uses Epilepsy, bipolar disorder, migraine headaches Adverse Effects Nausea, vomiting, indigestion Hepatotoxicity, pancreatitis, fetal harm Weight gain, rash, hair loss, tremor Blood dyscrasias
MORPHINE
MORPHINE Opioid Analgesic
Opioid Analgesic
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Activates mu receptors Produces analgesia, euphoria, sedation
Uses Relief of pain Adverse Effects Respiratory depression, constipation Orthostatic hypotension, urinary retention, miosis Biliary colic, euphoria, sedation, cough suppression Tolerance and physical dependence Reversed with naloxone (Narcan)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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NALOXONE (NARCAN)
NALOXONE (NARCAN) Opioid Antagonist
Opioid Antagonist
Reverses the effects of opioids
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Uses
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Opioid overdose Reversal of excessive respiratory depression
Adverse Effects Minimal
SUMATRIPTAN (IMITREX)
SUMATRIPTAN (IMITREX) Serotonin1B/1D-Receptor Agonist (Triptan)
Serotonin1B/1D-Receptor Agonist (Triptan)
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Binds to 5-HT1B/1D receptors to cause vasoconstriction Reduces release of inflammatory peptides Diminishes perivascular inflammation
Uses Migraine headache
Adverse Effects Chest pressure, coronary vasospasm Fetal harm
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)
CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)
Chlorpromazine (Thorazine) Thioridazine (Mellaril) Haloperidol (Haldol)
Relieve positive symptoms of schizophrenia Block receptors for dopamine, acetylcholine (ACh), histamine, and norepinephrine (NE)
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Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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
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
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ATYPICAL ANTIPSYCHOTICS
Uses 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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Antidepressants
Antidepressants
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Inhibit serotonin reuptake (more serotonin is available at the synapse)
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Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro)
Uses Major depression, OCD Panic disorder, PTSD, PMDD Adverse Effects Sexual dysfunction, nausea, headache, insomnia Weight gain, serotonin syndrome Withdrawal syndrome
TRICYCLIC ANTIDEPRESSANTS (TCAs)
TRICYCLIC ANTIDEPRESSANTS (TCAs) Antidepressants Inhibit reuptake of NE and serotonin (more serotonin and NE available at the synapse)
Antidepressants
Uses Depression, bipolar disorder, insomnia, and neuropathic pain
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Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan)
Adverse Effects Orthostatic hypotension, sedation Anticholinergic effects Cardiotoxicity, seizures, hypomania Many drug interactions SSRIs preferred for treatment of depression
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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MONOAMINE OXIDASE INHIBITORS (MAOIs)
MONOAMINE OXIDASE INHIBITORS (MAOIs) Antidepressants
Antidepressants
Increase NE and serotonin by blocking enzyme that inactivates them
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Uses
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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
LITHIUM Mood-Stabilizing Drug
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Mechanism unclear, may alter ions and neurotransmitters
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Uses 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 Anticonvulsant
Suppresses mania and stabilizes mood
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Uses
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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 Anticonvulsant
Newer Mood-Stabilizing Anticonvulsant
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Shows some efficacy in treating bipolar disorder
Uses Bipolar disorder Adverse Effects Headache, dizziness, double vision Life-threatening rashes include Stevens-Johnson syndrome and epidermal necrolysis
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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BENZODIAZEPINES (BZDs)
BENZODIAZEPINES (BZDs) Sedative Hypnotic Drugs
Sedative-Hypnotic Drugs
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Depress central nervous system function Reduce anxiety, promote sleep Potentiate the actions of GABA (an inhibitory neurotransmitter)
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Alprazolam (Xanax) Diazepam (Valium) Flurazepam (Dalmane) Lorazepam (Ativan) Midazolam (Versed) Temazepam (Restoril)
Uses Anxiety, insomnia, seizure disorder, induction of anesthesia 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 Abuse and addiction, teratogenic Do not mix with other CNS depressants or alcohol Reversal agent is flumazenil (Romazicon)
ZOLPIDEM (AMBIEN) ZALEPLON (SONATA)
ZOLPIDEM (AMBIEN) Sedative-Hypnotics BZD-like Drugs
Sedative-Hypnotics BZD-like Drugs Fold here
Potentiate the actions of GABA (an inhibitory neurotransmitter)
Uses Short-term management of insomnia
Adverse Effects Daytime drowsiness, dizziness Do not use with alcohol or other CNS depressants
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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BARBITURATES
BARBITURATES CNS Depressants
Thiopental (Pentothal) Secobarbital (Seconal) Phenobarbital
Potentiate the actions of GABA (an inhibitory neurotransmitter)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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Uses
CNS Depressants
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, METADATE, CONCERTA)
METHYLPHENIDATE (RITALIN, METADATE, CONCERTA) CNS Stimulant for ADHD
CNS Stimulant for ADHD Fold here
Promotes norepinephrine (NE) and dopamine (DA) release Inhibits NE and DA reuptake
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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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
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Uses
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ADHD in children and adults
Adverse Effects GI reactions, reduced appetite, dizziness, and somnolence Urinary retention, mood swings, insomnia, sexual dysfunction
ADDERALL
ADDERALL CNS Stimulant Used for ADHD Combination Amphetamine
CNS Stimulant Used for ADHD Combination Amphetamine Fold here
Uses ADHD
Adverse Effects Insomnia, growth suppression Headache, abdominal pain, lethargy Abuse potential (Schedule II) Sudden death Drug holidays recommended
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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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
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Uses
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Alcohol abuse
Adverse Effects Nausea, vomiting, flushing, palpitations, headache Sweating, blurry vision, hypotension, chest pain, shock will occur with 7 mL of alcohol ingestion
FUROSEMIDE (LASIX)
FUROSEMIDE (LASIX) Loop Diuretic
Loop Diuretic
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Blocks reabsorption of sodium and chloride in the descending limb of the loop of Henle to promote urination Produces profound diuresis
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 Inc.
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HYDROCHLOROTHIAZIDE (HCTZ)
HYDROCHLOROTHIAZIDE (HCTZ) Thiazide Diuretic
Thiazide Diuretic
Blocks reabsorption of sodium and chloride in the early segment of the distal convoluting tubule to promote urination
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Uses
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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) Potassium-Sparing Diuretic
Potassium-Sparing Diuretic
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Blocks the actions of aldosterone in the distal nephron Causes the retention of potassium and increased excretion of sodium
Uses Hypertension and edema Heart failure Primary hyperaldosteronism Adverse Effects Endocrine effects such as: Gynecomastia, menstrual irregularities, impotence, and hirsutism Hyperkalemia
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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ENALAPRIL (VASOTEC)
ENALAPRIL (VASOTEC) Angiotensin-Converting Enzyme (ACE) Inhibitor
Angiotensin-Converting Enzyme (ACE) Inhibitors
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Inhibits ACE, reducing levels of angiotensin II Dilates arterioles and veins to reduce BP Reduces blood volume
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Benazepril (Lotensin) Fosinopril (Monopril) Lisinopril (Prinivil and Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)
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)
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Angiotensin II-Receptor Blockers (ARBs)
Blocks the actions of angiotensin II Dilates arterioles and veins to reduce BP Reduces blood volume
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM)
VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM) Calcium Channel Blockers (CCBs) Nondihydropyridines Fold here
Calcium Channel Blockers (CCBs) Nondihydropyridines
Block calcium channels in the heart and blood vessels Reduce BP by blocking calcium channels in 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 Adverse Effects
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Constipation, dizziness, facial flushing, edema, hypotension Bradycardia, AV block, decreased cardiac contractility
AMLODIPINE (NORVASC)
AMLODIPINE (NORVASC) Calcium Channel Blocker
Calcium Channel Blocker Dihydropyridine Fold here
Dihydropyridine 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
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DIGOXIN (LANOXIN)
DIGOXIN (LANOXIN) Cardiac Glycoside Positive Inotropic Agent Drug for Heart Failure
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Cardiac Glycoside Positive Inotropic Agent Drug for Heart Failure
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 activity of the heart and slows heart rate
Uses Heart failure and dysrhythmias
Adverse Effects
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Inject slowly over 5 minutes Give Digibind for digoxin overdose
AMIODARONE (CORDARONE)
AMIODARONE (CORDARONE) Antidysrhythmic Class III Potassium Channel Blocker
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Antidysrhythmic Class III Potassium Channel Blocker
Delays repolarization Reduces automaticity in the SA node, reduces contractility Decreases conduction velocity in the 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 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 Fold here
Antidysrhythmics Class IV Calcium Channel Blockers
Block calcium channels in the heart Slow SA node automaticity, delay AV nodal conduction Reduce myocardial contractility
Uses Atrial fibrillation or atrial flutter Supraventricular tachycardia
Adverse Effects
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Bradycardia, AV block, and heart failure Hypotension, peripheral edema, and constipation Can elevate digoxin levels Grapefruit juice increases levels to toxicity
PROCAINAMIDE (PRONESTYL)
PROCAINAMIDE (PRONESTYL) Antidysrhythmic Class IA Sodium Channel Blocker
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Antidysrhythmic Class IA Sodium Channel Blocker
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
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Antidysrhythmic Class IB Sodium Channel Blocker
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 Inc.
PROPRANOLOL (INDERAL) Antidysrhythmic Class II Beta Blocker
PROPRANOLOL (INDERAL)
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Antidysrhythmic Class II Beta Blocker
Beta-adrenergic antagonist Blocks both beta1 and beta2 receptors Decreases automaticity of the SA node Decreases velocity of conduction through the AV node Decreases myocardial contractility
Uses Sinus tachycardia, severe recurrent ventricular tachycardia Paroxysmal atrial tachycardia, hypertension
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ATORVASTATIN (LIPITOR) FLUVASTATIN (LESCOL) LOVASTATIN (MEVACOR) PRAVASTATIN (PRAVACHOL) SIMVASTATIN (ZOCOR) ROSUVASTATIN (CRESTOR)
ATORVASTATIN (LIPITOR) Lipid-Lowering Drug HMG-CoA Reductase Inhibitor (Statin)
Lipid-Lowering Drugs HMG-CoA Reductase Inhibitors (Statins)
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Adverse Effects Prolongs PR interval on the ECG Bradycardia, heart failure, AV block, and sinus arrest Bronchospasm in patients with asthma
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Hepatotoxicity, increases ALT and AST Myopathy, increases CK levels, rhabdomyolysis, dark urine, renal failure Pregnancy Risk Category X Headache, rash, GI complaints Cyclosporine, macrolide antibiotics, azole antifungals, and HIV protease inhibitors raise some statins to toxic levels
NICOTINIC ACID (NIACIN)
NICOTINIC ACID (NIACIN) Lipid-Lowering Agent
Lipid-Lowering Agent
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Reduces LDL and triglycerides Increases HDL
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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CHOLESTYRAMINE (QUESTRAN) COLESEVELAM (WELCHOL)
CHOLESTYRAMINE (QUESTRAN) Bile-Acid Sequestrant
Bile-Acid Sequestrants
Forms insoluble complex with bile acids Increases LDL receptors Safest of all lipid-lowering drugs
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Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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) Fibric Acid Derivative (Fibrate)
Fibric Acid Derivatives (Fibrates)
Decreases triglycerides by lowering VLDL Raises HDL levels
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GEMFIBROZIL (LOPID) FENOFIBRATE (TRICOR)
Uses Hypertriglyceridemia Adverse Effects Myopathy, liver injury Rash, nausea, abdominal pain, diarrhea Gallstone formation Increases warfarin levels, leading to hemorrhage
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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EZETIMIBE (ZETIA)
EZETIMIBE (ZETIA) Cholesterol-Lowering Drug
Cholesterol-Lowering Drug
Blocks cholesterol absorption in the small intestine
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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
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Dilates veins, decreases venous return to the heart Decreases preload Decreases cardiac oxygen demand
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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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 Fold here
Blocks enzyme so that platelets are unable to aggregate
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses Prevention of stroke and MI Adverse Effects Hemorrhage
EPTIFIBATIDE (INTEGRILIN)
EPTIFIBATIDE (INTEGRILIN) Glycoprotein llb/llla–Receptor Antagonists Antiplatelet Drug—”Super Aspirin”
Glycoprotein llb/llla–Receptor Antagonists Antiplatelet Drug—”Super Aspirin” Fold here
Interferes with the final step in platelet aggregation
Uses Acute coronary syndrome Used during angioplasty
Adverse Effects Intercranial hemorrhage, gastrointestinal bleeding Hematuria, gingival bleeding Thrombocytopenia Anaphylaxis
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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ALTEPLASE (tPA)
ALTEPLASE (tPA) Thrombolytic Drug
Thrombolytic Drug
Converts plasminogen to plasmin Plasmin is an enzyme that digests the fibrin matrix of clots
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Acute myocardial infarction, pulmonary embolism, and ischemic stroke
Adverse Effects Bleeding Intracranial hemorrhage
HEPARIN
HEPARIN Parenteral Anticoagulant
Parenteral Anticoagulant
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Suppresses the formation of fibrin in veins Inactivates clotting factors thrombin and Xa Anticoagulant effect develops quickly
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
Adverse Effects Bleeding—antidote is protamine sulfate Heparin-induced thrombocytopenia (HIT) (Decreased platelet count 100,000 leads to thrombosis) May be used during pregnancy
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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WARFARIN (COUMADIN)
WARFARIN (COUMADIN) Oral Anticoagulant
Oral Anticoagulant
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Suppresses coagulation by antagonizing vitamin K Blocks synthesis of factors VII, IX, X, and prothrombin Effect takes a few days
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
Adverse Effects Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Hemorrhage—antidote is vitamin K Fetal harm
FERROUS SULFATE
FERROUS SULFATE Oral Iron Preparation
Oral Iron Preparation Uses
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Iron deficiency anemia (microcytic hypochromic anemia)
Adverse Effects Nausea, heartburn, bloating, constipation, diarrhea Liquid iron preparation stains teeth Toxic to children (lethal dose is 2 to 10 grams)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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CYANOCOBALAMIN (VITAMIN B12)
CYANOCOBALAMIN (VITAMIN B12)
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Essential for synthesis of DNA Catalyzes conversion of folic acid to its active form
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses B12 deficiency, pernicious anemia Macrocytic normochromic anemia (megaloblastic anemia) Adverse Effects Hypokalemia
FOLIC ACID (FOLATE)
FOLIC ACID (FOLATE) Essential for synthesis of DNA
Uses
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Treatment of folic acid deficiency (megaloblastic anemia) Used prophylactically to prevent neural tube defects (NTDs)
Adverse Effects Folic acid does not correct neurologic consequences Will correct anemia, but may mask B12 deficiency Always give folic acid with B12
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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OPRELVEKIN (INTERLEUKIN-11)
OPRELVEKIN (INTERLEUKIN-11) Thrombopoietic Growth Factor
Thrombopoietic Growth Factor
Stimulates production of platelets (thrombocytes)
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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
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Stimulates production of red blood cells
Uses Anemia of chronic renal failure Anemia due to AIDS treatment with AZT (zidovudine) Anemia caused by chemotherapy Adverse Effects Hypertension Increase in cardiovascular events Red cell aplasia
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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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
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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) Oral Hypoglycemic Agent Sulfonylurea
Oral Hypoglycemic Agents Sulfonylureas
Stimulates insulin release from the pancreas
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GLIPIZIDE (GLUCOTROL) GLYBURIDE (MICRONASE) GLIMEPIRIDE (AMARYL)
Uses Type 2 diabetes
Adverse Effects Hypoglycemia Fetal harm
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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METFORMIN (GLUCOPHAGE)
METFORMIN (GLUCOPHAGE) Oral Hypoglycemic Agent Biguanide
Oral Hypoglycemic Agent Biguanide Fold here
Decreases blood sugar by decreasing production of glucose in the liver Enhances glucose uptake and utilization in muscle
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses Type 2 diabetes
Adverse Effects Decreased appetite, nausea, diarrhea, and weight loss Lactic acidosis Avoid in patients with renal or liver disease Avoid 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)
Increases insulin sensitivity
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Thiazolidinediones (TZDs) “Glitazones” Insulin Sensitizers
ROSIGLITAZONE (AVANDIA) Thiazolidinedione (TZD) “Glitazone” Insulin Sensitizer
Uses Type 2 diabetes
Adverse Effects Fluid retention—caution in patients with CHF Hepatotoxicity—monitor ALT
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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MIGLITOL (GLYSET) ACARBOSE (PRECOSE)
MIGLITOL (GLYSET) ACARBOSE (PRECOSE) Alpha-Glucosidase Inhibitors Hypoglycemic Agent Fold here
Alpha-Glucosidase Inhibitors Hypoglycemic Agents
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Delay absorption of carbohydrates Lower postprandial blood glucose levels
Uses Type 2 diabetes Adverse Effects Flatulence, cramps, abdominal distention, diarrhea Hypoglycemia, liver dysfunction
REPAGLINIDE (PRANDIN) NATEGLINIDE (STARLIX)
REPAGLINIDE (PRANDIN) NATEGLINIDE (STARLIX) Meglitinides Hypoglycemic Agents
Meglitinides Hypoglycemic Agents Fold here
Stimulate pancreatic insulin release
Uses Type 2 diabetes
Adverse Effects Hypoglycemia Administer 30 minutes before meal
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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GLUCAGON
GLUCAGON
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Hormone that increases plasma levels of glucose Opposite effect of insulin
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses Treats hypoglycemia from insulin overdose Used only if IV glucose is not available
LEVOTHYROXINE (SYNTHROID, LEVOXYL)
LEVOTHYROXINE (SYNTHROID, LEVOXYL) Thyroid Replacement Hormone Synthetic Preparation of T4
Thyroid Replacement Hormone Synthetic Preparation of T4 Fold here
Converted to T3 in the body Thyroid hormone replacement
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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PROPYLTHIOURACIL (PTU)
PROPYLTHIOURACIL (PTU) Antithyroid Drug
Antithyroid Drug
Inhibits thyroid hormone synthesis
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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
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Uses 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 axis Glucose intolerance (increases blood sugar), osteoporosis, infection Growth retardation, mood changes, cataracts, glaucoma Peptic ulcer disease, iatrogenic Cushing’s syndrome Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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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 Fold here
Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Blocker
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Alpha-Adrenergic Antagonist Alpha Blocker
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 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 immunocompromised patients
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Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
CYCLOSPORINE (SANDIMMUNE)
CYCLOSPORINE (SANDIMMUNE) Immunosuppressant Drug
Immunosuppressant Drug
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Suppresses production of inflammatory cells Decreases B cells and cytotoxic T cells
Uses Organ transplant Adverse Effects Nephrotoxicity, infection, hepatotoxicity, lymphomas Hypertension, anaphylaxis, fetal harm
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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METHOTREXATE (RHEUMATREX, TREXALL)
METHOTREXATE (RHEUMATREX, TREXALL) Cytotoxic Drug Immunosuppressant Disease-Modifying Antirheumatic Drug (DMARD) Fold here
Cytotoxic Drug Immunosuppressant Disease-Modifying Antirheumatic Drug (DMARD)
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’s lymphoma Lymphocytic leukemia, psoriasis
Adverse Effects Bone marrow suppression, hepatic fibrosis GI ulceration, pneumonitis, and fetal harm Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
DIPHENHYDRAMINE (BENADRYL)
DIPHENHYDRAMINE (BENADRYL) First-Generation H1 Antagonist Antihistamine
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First-Generation H1 Antagonist Antihistamine
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 reactions
Adverse Effects Sedation, confusion, nausea, and dry throat Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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LORATADINE (CLARITIN) DESLORATADINE (CLARINEX) FEXOFENADINE (ALLEGRA) CETIRIZINE (ZYRTEC)
LORATADINE (CLARITIN) Second-Generation Nonsedating H1 Antagonist (Antihistamine)
Second-Generation Nonsedating H1 Antagonists (Antihistamines)
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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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
ASPIRIN
ASPIRIN Antiplatelet Drug Cyclooxygenase (COX) Inhibitor First-Generation NSAID Fold here
Antiplatelet Drug Cyclooxygenase (COX) Inhibitor First-Generation NSAID
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 Adverse Effects Bleeding, gastric ulceration, renal impairment Not used in children because of Reye’s syndrome Fetal harm, salicylism Hypersensitivity in patients with allergies
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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IBUPROFEN (ADVIL, MOTRIN)
IBUPROFEN (ADVIL, MOTRIN) First-Generation NSAID
First-Generation NSAID
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Inhibits cyclooxygenase (COX)-1 and COX-2 Inhibits prostaglandin synthesis Has antiinflammatory, analgesic, and antipyretic actions
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 COX-2 Inhibitor
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Second-Generation NSAID COX-2 Inhibitor
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 Inc.
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ACETAMINOPHEN (TYLENOL)
ACETAMINOPHEN (TYLENOL) Analgesic Antipyretic
Analgesic Antipyretic Fold here
Decreases prostaglandin synthesis in the CNS Devoid of antiinflammatory properties
Uses Pain and fever Preferred in children No GI injury, no effect on platelets or kidneys
Adverse Effects Toxic metabolite builds up in ETOH abusers Hepatic necrosis can occur Acetylcysteine (Mucomyst) given for overdose Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
FLUTICASONE PROPIONATE (FLOVENT)
FLUTICASONE PROPIONATE (FLOVENT) Inhaled Corticosteroid (ICS)
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Inhaled Corticosteroid (ICS)
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Beta2-Adrenergic Agonist
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Long-Acting Inhaled Beta2-Adrenergic Agonist
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 (SINGULAIR)
MONTELUKAST (SINGULAIR) Leukotriene Modifier
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Leukotriene Modifier
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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THEOPHYLLINE
THEOPHYLLINE Methylxanthine Bronchodilator
Methylxanthine Bronchodilator Fold here
Produces bronchodilation by relaxing bronchi
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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
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Beta2-Adrenergic Agonist Bronchodilator
Stimulates beta2 receptors in the lung Bronchodilation Rapid onset of action for rescue breathing
Uses Asthma Adverse Effects Hyperglycemia, tachycardia, tremor
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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RANITIDINE (ZANTAC) CIMETIDINE (TAGAMET) FAMOTIDINE (PEPCID) NIZATIDINE (AXID)
RANITIDINE (ZANTAC) Histamine2-Receptor Antagonist
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses
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Histamine2-Receptor Antagonists
Blocks H2 receptors on parietal cells of the stomach Reduces volume of gastric juice and hydrogen ion content 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)
Inhibits the enzyme that generates acid production
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Proton Pump Inhibitors (PPIs)
OMEPRAZOLE (PRILOSEC) Proton Pump Inhibitor (PPI)
Uses Duodenal and gastric ulcers, GERD, dyspepsia Zollinger-Ellison syndrome Adverse Effects Headache, diarrhea, nausea, and vomiting
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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SUCRALFATE (CARAFATE)
SUCRALFATE (CARAFATE) Antiulcer drug
Antiulcer drug
Creates a protective barrier against acid and pepsin Sticky gel adheres to ulcer crater
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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
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Reduces emesis by blocking receptors in the chemoreceptor trigger zone (CTZ) Increases upper GI motility by enhancing the actions of ACh
Uses Suppresses nausea caused by chemotherapy Suppresses postoperative emesis and GERD
Adverse Effects Sedation and diarrhea Extrapyramidal reactions, especially in children
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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SULFASALAZINE (AZULFIDINE)
SULFASALAZINE (AZULFIDINE) Aminosalicylate
Aminosalicylate
Reduces inflammation
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Antagonist
Antiemetic Drug Serotonin-Receptor Antagonist Fold here
Suppresses emesis by blocking 5-HT3 receptors in the chemoreceptor trigger zone (CTZ)
Uses Decreases nausea and vomiting due to: Chemotherapy, radiation therapy, and anesthesia (postoperatively) Adverse Effects Headache, nausea, and dizziness
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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PROCHLORPERAZINE (COMPAZINE) PROMETHAZINE (PHENERGAN)
PROCHLORPERAZINE (COMPAZINE) Antiemetic Drug Dopamine Antagonist
Antiemetic Drugs Dopamine Antagonists Fold here
Suppresses emesis by blocking dopamine2 receptors in the CTZ
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Fold here
Blocks histaminergic and cholinergic receptors
Uses Nausea
Adverse Effects Sedation, blurry vision, urinary retention, dry mouth
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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PENICILLIN G (BENZYLPENICILLIN)
PENICILLIN G (BENZYLPENICILLIN) Narrow-Spectrum Penicillin
Narrow-Spectrum Penicillin
Weakens the bacterial cell wall
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 (Antistaphylococcal Penicillin)
Penicillinase-Resistant Penicillin (Antistaphylococcal Penicillin) Fold here
Weakens the cell wall
Uses Treats infections caused by Staphylococcus aureus
Adverse Effects Allergic reaction, GI effects Thrombophlebitis, hypokalemia
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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AMOXICILLIN (AMOXIL)
AMOXICILLIN (AMOXIL) Broad-Spectrum Penicillin (Aminopenicillin)
Broad-Spectrum Penicillin (Aminopenicillin)
Weakens the bacterial cell wall
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Beta-Lactam Antibiotic
First-Generation Cephalosporin Beta-Lactam Antibiotic Fold here
Weakens the bacterial cell wall
Uses Gram-positive infections Surgical prophylaxis
Adverse Effects Allergic reaction Bleeding tendencies Thrombophlebitis Antibiotic-associated pseudomembranous colitis (AAPMC)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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CEFUROXIME (CEFTIN)
CEFUROXIME (CEFTIN) Second-Generation Cephalosporin Beta-Lactam Antibiotic
Second-Generation Cephalosporin Beta-Lactam Antibiotic Fold here
Weakens the bacterial cell wall
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses Upper respiratory tract infections Acute otitis media (AOM) and sinusitis Adverse Effects Allergic reaction Bleeding tendencies Thrombophlebitis Antibiotic-associated pseudomembranous colitis (AAPMC)
CEFTRIAXONE (ROCEPHIN)
CEFTRIAXONE (ROCEPHIN) Third-Generation Cephalosporin Beta-Lactam Antibiotic
Third-Generation Cephalosporin Beta-Lactam Antibiotic Fold here
Weakens the bacterial cell wall
Uses Active against gram-negative organisms
Adverse Effects Allergic reaction Bleeding tendencies Thrombophlebitis Antibiotic-associated pseudomembranous colitis (AAPMC)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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VANCOMYCIN (VANCOCIN)
VANCOMYCIN (VANCOCIN) Antibiotic
Antibiotic
Inhibits bacterial cell wall synthesis
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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 Suppresses bacterial growth by inhibiting protein synthesis
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Broad-Spectrum Antibiotics
Uses 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 Photosensitivity, vestibular toxicity
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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ERYTHROMYCIN CLARITHROMYCIN (BIAXIN) AZITHROMYCIN (ZITHROMAX) DIRITHROMYCIN (DYNABAC) TELITHROMYCIN (KETEK)
ERYTHROMYCIN Macrolide Antibiotic Broad-Spectrum Antibiotic
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Macrolide Antibiotics Broad-Spectrum Antibiotics
Inhibits bacterial cell wall synthesis
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 Inc.
CLINDAMYCIN (CLEOCIN)
CLINDAMYCIN (CLEOCIN) Antibiotic
Antibiotic
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Inhibits bacterial protein synthesis
Uses Active against most anaerobic bacteria outside the CNS Bacteroides fragilis, Fusobacterium, Clostridium perfringens Adverse Effects Antibiotic-associated pseudomembranous colitis (AAPMC) Diarrhea
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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GENTAMICIN (GARAMYCIN) AMIKACIN (AMIKIN) TOBRAMYCIN (NEBCIN)
GENTAMICIN (GARAMYCIN) Aminoglycoside Antibiotic Narrow-Spectrum Antibiotic
Aminoglycoside Antibiotics Narrow-Spectrum Antibiotics
Disrupts bacterial protein synthesis
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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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 Fold here
Combination antibiotic that inhibits bacterial synthesis of folic acid
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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CIPROFLOXACIN (CIPRO) MOXIFLOXACIN (AVELOX) GATIFLOXACIN (TEQUIN) LEVOFLOXACIN (LEVAQUIN)
CIPROFLOXACIN (CIPRO) Fluoroquinolone Antibiotic
Fluoroquinolone Antibiotics
Infections of the urinary, respiratory, and GI tracts; bones; joints; skin; and soft tissues
Inhibits bacterial DNA
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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Uses
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 (FLAGYL)
METRONIDAZOLE (FLAGYL) Antibacterial Drug
Antibacterial Drug
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Causes cell death by damaging bacterial DNA
Uses 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 Inc.
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KETOCONAZOLE (NIZORAL) FLUCONAZOLE (DIFLUCAN) ITRACONAZOLE (SPORANOX) MICONAZOLE (MONISTAT) CLOTRIMAZOLE
KETOCONAZOLE (NIZORAL) Antifungal Agent
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Uses
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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
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Inhibits fungal mitosis
Uses 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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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ACYCLOVIR (ZOVIRAX) VALACYCLOVIR (VALTREX) FAMCICLOVIR (FAMVIR)
ACYCLOVIR (ZOVIRAX) Antiviral Agent Suppresses synthesis of viral DNA
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Uses
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
Herpesvirus, varicella-zoster virus, cytomegalovirus (CMV)
Adverse Effects IV administration can lead to phlebitis and 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
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Decreases viral replication
Uses Hepatitis B and C Adverse Effects Flulike syndrome Depression Fatigue, hair loss, thyroid damage, heart damage Bone marrow suppression
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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RIBAVIRIN (REBETOL)
RIBAVIRIN (REBETOL) Antiviral Agent
Antiviral Agent
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Uses Used with interferon for treatment of hepatitis C
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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)
Suppress the synthesis of viral DNA by blocking transcriptase
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Zidovudine (Retrovir) Lamivudine (Epivir) Zalcitabine (Hivid) Antiretroviral Drugs
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs) Antiretroviral Drugs
Uses HIV infection
Adverse Effects Anemia, neutropenia, lactic acidosis
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)
NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs) Antiretroviral Drugs
Delavirdine (Rescriptor) Efavirenz (Sustiva) Nevirapine (Viramune)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Drugs
Inhibit reverse transcriptase by binding to it
Uses HIV infection Adverse Effects Rash, Stevens-Johnson syndrome, erythema multiforme Hepatotoxicity
PROTEASE INHIBITORS
PROTEASE INHIBITORS Antiretroviral Drugs Inhibit the enzyme protease, needed for HIV to mature
Antiretroviral Drugs
Uses HIV
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Nelfinavir (Viracept) Ritonavir (Norvir) Saquinavir (Invirase)
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
Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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Copyright © 2007 by Saunders, an imprint of Elsevier Inc.
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