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

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

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

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

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

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

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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

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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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