Pharmacology Flash Cards

Drug Receptor Types
Functions of Peripheral Adrenergic Receptor Subtypes

Receptor Subtype Alpha1 Location Eye Arterioles (skin, viscera, mucous membranes) Veins Sex organs, male Bladder neck and prostatic capsule Presynaptic nerve terminals Heart Kidney Arterioles (heart, lung, and skeletal mucle) Bronchi Uterus Liver Skeletal muscle Kidney Response to Receptor Activation Mydriasiswide eyed with fear Constriction Constriction Ejaculation Contraction Inhibition of transmitter releasedecreases sympathetic nervous system (SNS) outow to the blood vessels and heart Increased rate, force of contraction, and AV conduction velocity Renin releaseRAS Dilation Dilation Relaxation Glycogenolysis Enhanced contraction, glycogenolysis Dilation of kidney vasculature
Functions of Peripheral Cholinergic Receptor Subtypes

Receptor Subtype Nicotinicn Location All autonomic nervous system ganglia and the adrenal medulla Response to Receptor Activation Stimulation of parasympathetic and sympathetic postganglionic nerves and release of epinephrine from the adrenal medulla Contraction of skeletal muscle 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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Alpha2 Beta1 Beta2
Nicotinicm Neuromuscular junction Muscarinic All parasympathetic target organs: Eye Heart Lung Bladder GI tract
Dopamine
Sweat glands Sex organs Blood vessels
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Drug Endings
Drug Endings -zosin -olol, -lol -zepam, -zolam -pril -artan -dipine -statin -ase, -plase -parin -sone -dronate Drug Classication 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 Drug Example prazosin metoprolol diazepam, alprazolam lisinopril candesartan amlodipine atorvastatin alteplase enoxaparin prednisone alendronate Continued Copyright 2007 by Saunders, an imprint of Elsevier Inc.
Drug Endingscontd
Drug Endings -terol -tidine -prazole -cillin -cef, -ceph -cycline -oxacin -thromycin -micin, -mycin -azole Drug Classication Bronchodilator Histamine2 blockeracid reducer Protein pump inhibitoracid reducer Penicillin antibiotic Cephalosporin antibiotic Tetracycline antibiotic Fluoroquinolone antibiotic Macrolide antibiotic Aminoglycoside antibiotic Antifungal Drug Example albuterol cimetidine omeprazole amoxicillin cefazolin tetracycline levooxacin azithromycin gentamycin itraconazole
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BETHANECHOL (URECHOLINE) Muscarinic Agonist
BETHANECHOL (URECHOLINE) Muscarinic Agonist

Activates muscarinic receptors Causes contraction of the detrusor muscle of the bladder
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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 Muscarinic Antagonist (Anticholinergic)
ATROPINE 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)
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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
Blurry vision, urinary retention, dry mouth, constipation, tachycardia Increases intraocular pressure
NEOSTIGMINE (PROSTIGMINE) Reversible Cholinesterase Inhibitor
NEOSTIGMINE (PROSTIGMINE) Reversible Cholinesterase Inhibitor

Prevents the degradation of acetylcholine (ACh) Enhances the effect of ACh to stimulate skeletal muscle
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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 crisistreat with atropine
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SUCCINYLCHOLINE Depolarizing Neuromuscular Blocker
SUCCINYLCHOLINE Depolarizing Neuromuscular Blocker

Causes paralysis of muscle by preventing repolarization
Uses
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Muscle relaxation during endotracheal intubation Used for short operative procedures
Adverse Effects
Prolonged paralysis in genetically determined individuals Malignant hyperthermiatreat with dantrolene Muscle pain, hyperkalemia
PHENYLEPHRINE Adrenergic Agonist
PHENYLEPHRINE Adrenergic Agonist

Activates alpha1 receptors Constricts blood vessels of the skin, viscera, and mucous membranes
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Uses Treatment of nasal congestion Delay of anesthetic absorption Dilation of the pupil for ocular exam Adverse Effects Hypertension Necrosis
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EPINEPHRINE Adrenergic Agonist (Catecholamine)
EPINEPHRINE Adrenergic Agonist (Catecholamine)

Activates all four adrenergic receptorsalpha1, alpha2, beta1, and beta2 Pupil dilation, arterial and venous vasoconstriction Increases heart rate and force of contraction Bronchial dilation, glycogenolysis, enhanced muscle contraction
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Uses
Cardiac arrest, heart failure, and anaphylactic shock AV heart block and asthma Delays absorption of local anesthetic and controls supercial 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

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PROPRANOLOL (INDERAL) 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
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) Adrenergic Antagonist Cardioselective Beta Blocker

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METOPROLOL (LOPRESSOR, TOPROL XL) 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
Bradycardia, reduction of cardiac output, AV heart block Rebound cardiac excitation following abrupt withdrawal
PRAZOSIN (MINIPRESS) Adrenergic Antagonist Alpha Blocker

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PRAZOSIN (MINIPRESS) 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 Adverse Effects Orthostatic hypotension, reex tachycardia Inhibition of ejaculation Nasal congestion Use with sildenal (Viagra), other drugs for erectile dysfunction, can lead to hypotension
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CLONIDINE (CATAPRES) Centrally Acting Alpha2 Agonist Antihypertensive Drug

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CLONIDINE (CATAPRES) Centrally Acting Alpha2 Agonist Antihypertensive Drug

Activates alpha2 receptors in the CNS Reduces sympathetic ow 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) Dopaminergic Agent
LEVODOPA/CARBIDOPA (SINEMET) Dopaminergic Agent

Levodopa increases synthesis of dopamine in the striatum Carbidopa enhances the effect of levodopa
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Uses Reduces symptoms of Parkinsons disease Adverse Effects Effects take several months to develop Loss of effect occurs over time Nausea, vomiting, dyskinesias Postural hypotension, psychosis Dark sweat and urine, may activate melanoma
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DONEPEZIL (ARICEPT) Cholinesterase Inhibitor
DONEPEZIL (ARICEPT) Cholinesterase Inhibitor

Prevents the breakdown of ACh Increases ACh at cholinergic synapses May slow progression of Alzheimers disease (AD) Some improvement of cognitive function
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Uses Alzheimers disease (AD) Adverse Effects Cholinergic effects Nausea, vomiting, dyspepsia, diarrhea Bradycardia, bronchoconstriction
PHENYTOIN (DILANTIN) Antiepileptic Drug (AED)
PHENYTOIN (DILANTIN) Antiepileptic Drug (AED)

Inhibits entry of sodium into neurons Suppresses action potential of neurons
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Uses Epilepsy Adverse Effects Nystagmus, sedation, ataxia, diplopia Cognitive impairment, gingival hyperplasia, hirsutism Rash, fetal harm, bleeding tendencies in newborns Narrow therapeutic range (10 to 20 mcg/mL) Can decrease the effect of other drugs such as: Oral contraceptives, warfarin, and glucocorticoids Inject slowly, use normal saline ush Withdraw over a period of 6 to 8 weeks to avoid seizures
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VALPROIC ACID (DEPAKOTE) Antiepileptic Drug (AED)
VALPROIC ACID (DEPAKOTE) Antiepileptic Drug (AED)

Blocks sodium channels to suppress neurons Suppresses calcium inux Increases inhibitory inuence 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 Opioid Analgesic
MORPHINE Opioid Analgesic

Activates mu receptors Produces analgesia, euphoria, sedation
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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)
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NALOXONE (NARCAN) Opioid Antagonist
NALOXONE (NARCAN) Opioid Antagonist

Reverses the effects of opioids
Uses
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Opioid overdose Reversal of excessive respiratory depression
Adverse Effects Minimal
SUMATRIPTAN (IMITREX) Serotonin1B/1D-Receptor Agonist (Triptan)
SUMATRIPTAN (IMITREX) Serotonin1B/1D-Receptor Agonist (Triptan)

Binds to 5-HT1B/1D receptors to cause vasoconstriction Reduces release of inammatory peptides Diminishes perivascular inammation
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Uses
Migraine headache
Adverse Effects Chest pressure, coronary vasospasm Fetal harm
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CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)

Chlorpromazine (Thorazine) Thioridazine (Mellaril) Haloperidol (Haldol)
CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)

Relieve positive symptoms of schizophrenia Block receptors for dopamine, acetylcholine (ACh), histamine, and norepinephrine (NE)
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Uses Schizophrenia, bipolar disorder, Tourettes 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)
ATYPICAL ANTIPSYCHOTICS
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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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
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SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Antidepressants

Inhibit serotonin reuptake (more serotonin is available at the synapse)
Antidepressants
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Uses Major depression, OCD Panic disorder, PTSD, PMDD Adverse Effects Sexual dysfunction, nausea, headache, insomnia Weight gain, serotonin syndrome Withdrawal syndrome
TRICYCLIC ANTIDEPRESSANTS (TCAs)

Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan)
TRICYCLIC ANTIDEPRESSANTS (TCAs) Antidepressants

Inhibit reuptake of NE and serotonin (more serotonin and NE available at the synapse)
Antidepressants
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Uses Depression, bipolar disorder, insomnia, and neuropathic pain Adverse Effects Orthostatic hypotension, sedation Anticholinergic effects Cardiotoxicity, seizures, hypomania Many drug interactions SSRIs preferred for treatment of depression
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MONOAMINE OXIDASE INHIBITORS (MAOIs) Antidepressants
MONOAMINE OXIDASE INHIBITORS (MAOIs) Antidepressants

Increase NE and serotonin by blocking enzyme that inactivates them
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

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

Suppresses mania and stabilizes mood
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) Newer Mood-Stabilizing Anticonvulsant
LAMOTRIGINE (LAMICTAL) Newer Mood-Stabilizing Anticonvulsant

Shows some efcacy in treating bipolar disorder
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Uses Bipolar disorder Adverse Effects

Headache, dizziness, double vision Life-threatening rashes include Stevens-Johnson syndrome and epidermal necrolysis
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BENZODIAZEPINES (BZDs)
Alprazolam (Xanax) Diazepam (Valium) Flurazepam (Dalmane) Lorazepam (Ativan) Midazolam (Versed) Temazepam (Restoril)
BENZODIAZEPINES (BZDs) Sedative Hypnotic Drugs

Depress central nervous system function Reduce anxiety, promote sleep Potentiate the actions of GABA (an inhibitory neurotransmitter)
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Sedative-Hypnotic Drugs
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 umazenil (Romazicon)
ZOLPIDEM (AMBIEN) ZALEPLON (SONATA) Sedative-Hypnotics BZD-like Drugs

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ZOLPIDEM (AMBIEN) Sedative-Hypnotics BZD-like Drugs

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
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BARBITURATES
Thiopental (Pentothal) Secobarbital (Seconal) Phenobarbital
BARBITURATES CNS Depressants

Potentiate the actions of GABA (an inhibitory neurotransmitter)
Uses
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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) CNS Stimulant for ADHD

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METHYLPHENIDATE (RITALIN, METADATE, CONCERTA) CNS Stimulant for ADHD

Promotes norepinephrine (NE) and dopamine (DA) release Inhibits NE and DA reuptake
Uses Attention decit/hyperactivity disorder (ADHD) Narcolepsy Adverse Effects Insomnia, reduced appetite, palpitations, hypertension, angina, dysrhythmias, psychosis Abrupt discontinuation can lead to withdrawal reactions Potential for abuse (Schedule II) Sudden death
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ATOMOXETINE (STRATTERA) Nonstimulant Drug for ADHD
ATOMOXETINE (STRATTERA) Nonstimulant Drug for ADHD

Selective inhibitor of NE reuptake Causes NE to accumulate at synapses
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 CNS Stimulant Used for ADHD Combination Amphetamine

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ADDERALL CNS Stimulant Used for ADHD Combination Amphetamine

Uses
ADHD
Adverse Effects Insomnia, growth suppression Headache, abdominal pain, lethargy Abuse potential (Schedule II) Sudden death Drug holidays recommended
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DISULFIRAM (ANTABUSE) Aversion Therapy for Alcoholism
DISULFIRAM (ANTABUSE) Aversion Therapy for Alcoholism

Disrupts alcohol metabolism by blocking enzyme Aldehyde accumulates and produces unpleasant effects
Uses
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Alcohol abuse
Adverse Effects
Nausea, vomiting, ushing, palpitations, headache Sweating, blurry vision, hypotension, chest pain, shock will occur with 7 mL of alcohol ingestion
FUROSEMIDE (LASIX) Loop Diuretic
FUROSEMIDE (LASIX) Loop Diuretic

Blocks reabsorption of sodium and chloride in the descending limb of the loop of Henle to promote urination Produces profound diuresis
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Uses
Rapid mobilization of uid Pulmonary edema resulting from heart failure or renal or liver disease Especially useful in patients with renal insufciency
Adverse Effects
Hypokalemia, hyponatremia, hypochloremia, dehydration, hypotension, and ototoxicity May cause dysrhythmias when used with digoxin (decreases potassium)
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HYDROCHLOROTHIAZIDE (HCTZ) Thiazide Diuretic
HYDROCHLOROTHIAZIDE (HCTZ) Thiazide Diuretic

Blocks reabsorption of sodium and chloride in the early segment of the distal convoluting tubule to promote urination
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) Potassium-Sparing Diuretic
SPIRONOLACTONE (ALDACTONE) Potassium-Sparing Diuretic

Blocks the actions of aldosterone in the distal nephron Causes the retention of potassium and increased excretion of sodium
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Uses Hypertension and edema Heart failure Primary hyperaldosteronism Adverse Effects
Endocrine effects such as: Gynecomastia, menstrual irregularities, impotence, and hirsutism Hyperkalemia
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ENALAPRIL (VASOTEC)
Benazepril (Lotensin) Fosinopril (Monopril) Lisinopril (Prinivil and Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)
ENALAPRIL (VASOTEC) Angiotensin-Converting Enzyme (ACE) Inhibitor

Inhibits ACE, reducing levels of angiotensin II Dilates arterioles and veins to reduce BP Reduces blood volume
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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
Angiotensin-Converting Enzyme (ACE) Inhibitors
LOSARTAN (COZAAR)
Candesartan (Atacand) Eprosartan (Teveten) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan)
LOSARTAN (COZAAR) Angiotensin II-Receptor Blocker (ARB)

Blocks the actions of angiotensin II Dilates arterioles and veins to reduce BP Reduces blood volume
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Uses
Hypertension, heart failure, MI, and diabetic nephropathy Prevention of MI, stroke, and death
Angiotensin II-Receptor Blockers (ARBs)
Adverse Effects
Renal failure in patients with renal artery stenosis Hypotension Angioedema Fetal injury Does not cause cough or hyperkalemia
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VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM) Calcium Channel Blockers (CCBs) Nondihydropyridines

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VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM) 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

Constipation, dizziness, facial ushing, edema, hypotension Bradycardia, AV block, decreased cardiac contractility
AMLODIPINE (NORVASC) Calcium Channel Blocker Dihydropyridine

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AMLODIPINE (NORVASC) Calcium Channel Blocker Dihydropyridine

Blocks calcium channels in the blood vessels Vasodilation in peripheral arterioles lowers blood pressure
Uses Hypertension Angina Adverse Effects Peripheral edema, ushing, dizziness, headache Does not slow heart rate like nondihydropyridines
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DIGOXIN (LANOXIN) 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
DIGOXIN (LANOXIN) Cardiac Glycoside Positive Inotropic Agent Drug for Heart Failure
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Uses
Heart failure and dysrhythmias
Adverse Effects
Anorexia, nausea and vomiting, fatigue Visual disturbances (blurry vision, yellow tinge, halos) Dysrhythmias Digoxin toxicity (therapeutic level 0.5 to 0.8 ng/mL) Hold if HR 60 BPM or K is low Inject slowly over 5 minutes Give Digibind for digoxin overdose
AMIODARONE (CORDARONE) Antidysrhythmic Class III Potassium Channel Blocker

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AMIODARONE (CORDARONE) 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 brillation 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) Antidysrhythmics Class IV Calcium Channel Blockers

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VERAPAMIL (CALAN) DILTIAZEM (CARDIZEM) 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 brillation or atrial utter Supraventricular tachycardia
Adverse Effects
Bradycardia, AV block, and heart failure Hypotension, peripheral edema, and constipation Can elevate digoxin levels Grapefruit juice increases levels to toxicity
PROCAINAMIDE (PRONESTYL) Antidysrhythmic Class IA Sodium Channel Blocker

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PROCAINAMIDE (PRONESTYL) 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 erythematouslike syndrome Blood dyscrasias QRS widening and prolongation
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LIDOCAINE (XYLOCAINE) Antidysrhythmic Class IB Sodium Channel Blocker

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LIDOCAINE (XYLOCAINE) 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 signicant impact on the ECG Drowsiness, confusion, and paresthesias Toxic doses may produce convulsions and respiratory arrest
PROPRANOLOL (INDERAL) Antidysrhythmic Class II Beta Blocker

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PROPRANOLOL (INDERAL) 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 Adverse Effects Prolongs PR interval on the ECG Bradycardia, heart failure, AV block, and sinus arrest Bronchospasm in patients with asthma
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ATORVASTATIN (LIPITOR) FLUVASTATIN (LESCOL) LOVASTATIN (MEVACOR) PRAVASTATIN (PRAVACHOL) SIMVASTATIN (ZOCOR) ROSUVASTATIN (CRESTOR)
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ATORVASTATIN (LIPITOR) Lipid-Lowering Drug HMG-CoA Reductase Inhibitor (Statin)

Inhibits the enzyme that synthesizes cholesterol Increases the number of LDL receptors to remove LDL Slows progression of CHD, stabilizes plaque
Lipid-Lowering Drugs HMG-CoA Reductase Inhibitors (Statins)
Uses
Hypercholesterolemia Primary prevention of CHD
Adverse Effects
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) Lipid-Lowering Agent
NICOTINIC ACID (NIACIN) Lipid-Lowering Agent

Reduces LDL and triglycerides Increases HDL
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Uses Dyslipidemia Adverse Effects Hepatotoxicity Flushing, itching Gastric upset, nausea, vomiting, diarrhea May raise blood sugar in patients with diabetes May increase incidence of gout
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CHOLESTYRAMINE (QUESTRAN) COLESEVELAM (WELCHOL) Bile-Acid Sequestrants

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CHOLESTYRAMINE (QUESTRAN) Bile-Acid Sequestrant

Forms insoluble complex with bile acids Increases LDL receptors Safest of all lipid-lowering drugs
Uses Hypercholesterolemia Often used in combination with statin Adverse Effects Constipation, bloating, indigestion Reduces uptake of fat-soluble vitamins Interferes with absorption of other drugs
GEMFIBROZIL (LOPID) FENOFIBRATE (TRICOR) Fibric Acid Derivatives (Fibrates)

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GEMFIBROZIL (LOPID) Fibric Acid Derivative (Fibrate)

Decreases triglycerides by lowering VLDL Raises HDL levels
Uses Hypertriglyceridemia Adverse Effects Myopathy, liver injury Rash, nausea, abdominal pain, diarrhea Gallstone formation Increases warfarin levels, leading to hemorrhage
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EZETIMIBE (ZETIA) Cholesterol-Lowering Drug
EZETIMIBE (ZETIA) Cholesterol-Lowering Drug

Blocks cholesterol absorption in the small intestine
Uses
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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 Organic Nitrate
NITROGLYCERINE Organic Nitrate

Dilates veins, decreases venous return to the heart Decreases preload Decreases cardiac oxygen demand
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Uses
Angina, myocardial infarction
Adverse Effects Headache, orthostatic hypotension Reex tachycardia Use with sildenal (Viagra), other drugs for erectile dysfunction may lead to severe hypotension
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CLOPIDOGREL (PLAVIX) Adenosine DiphosphateReceptor Antagonist ADP Receptor Blocker Antiplatelet Drug
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CLOPIDOGREL (PLAVIX) Adenosine DiphosphateReceptor Antagonist ADP Receptor Blocker Antiplatelet Drug
Blocks enzyme so that platelets are unable to aggregate
Uses Prevention of stroke and MI Adverse Effects Hemorrhage
EPTIFIBATIDE (INTEGRILIN) Glycoprotein llb/lllaReceptor Antagonists Antiplatelet DrugSuper Aspirin

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EPTIFIBATIDE (INTEGRILIN) Glycoprotein llb/lllaReceptor Antagonists Antiplatelet DrugSuper Aspirin

Interferes with the nal step in platelet aggregation
Uses
Acute coronary syndrome Used during angioplasty
Adverse Effects
Intercranial hemorrhage, gastrointestinal bleeding Hematuria, gingival bleeding Thrombocytopenia Anaphylaxis
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ALTEPLASE (tPA) Thrombolytic Drug
ALTEPLASE (tPA) Thrombolytic Drug

Converts plasminogen to plasmin Plasmin is an enzyme that digests the brin matrix of clots
Uses
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Acute myocardial infarction, pulmonary embolism, and ischemic stroke
Adverse Effects Bleeding Intracranial hemorrhage
HEPARIN Parenteral Anticoagulant
HEPARIN Parenteral Anticoagulant

Suppresses the formation of brin in veins Inactivates clotting factors thrombin and Xa Anticoagulant effect develops quickly
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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
Bleedingantidote is protamine sulfate Heparin-induced thrombocytopenia (HIT) (Decreased platelet count 100,000 leads to thrombosis) May be used during pregnancy
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Suppresses coagulation by antagonizing vitamin K Blocks synthesis of factors VII, IX, X, and prothrombin Effect takes a few days
WARFARIN (COUMADIN) Oral Anticoagulant
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Uses
Long-term prophylaxis of venous thrombosis Used in patients with mechanical heart valves Used in patients with atrial brillation
Monitoring
Prothrombin time (PT)reported as INR Goal INR for atrial brillation is 23 Goal INR for mechanical valves is 34.5
Adverse Effects
Hemorrhageantidote is vitamin K Fetal harm
FERROUS SULFATE Oral Iron Preparation
FERROUS SULFATE Oral Iron Preparation

Uses
Iron deciency anemia (microcytic hypochromic anemia)
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Adverse Effects
Nausea, heartburn, bloating, constipation, diarrhea Liquid iron preparation stains teeth Toxic to children (lethal dose is 2 to 10 grams)
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CYANOCOBALAMIN (VITAMIN B12)
CYANOCOBALAMIN (VITAMIN B12)

Essential for synthesis of DNA Catalyzes conversion of folic acid to its active form
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Uses B12 deciency, pernicious anemia Macrocytic normochromic anemia (megaloblastic anemia) Adverse Effects Hypokalemia
FOLIC ACID (FOLATE)
FOLIC ACID (FOLATE)

Essential for synthesis of DNA
Uses
Treatment of folic acid deciency (megaloblastic anemia) Used prophylactically to prevent neural tube defects (NTDs)
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Adverse Effects
Folic acid does not correct neurologic consequences Will correct anemia, but may mask B12 deciency Always give folic acid with B12
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OPRELVEKIN (INTERLEUKIN-11) Thrombopoietic Growth Factor
OPRELVEKIN (INTERLEUKIN-11) Thrombopoietic Growth Factor

Stimulates production of platelets (thrombocytes)
Uses
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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) Hematopoietic Growth Factor
EPOETIN ALFA (ERYTHROPOIETIN) Hematopoietic Growth Factor

Stimulates production of red blood cells
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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
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FILGRASTIM (NEUPOGEN) Granulocyte Colony Stimulating Factor (G-CSF)
FILGRASTIM (NEUPOGEN) Granulocyte Colony Stimulating Factor (G-CSF)

Acts on bone marrow to increase production of neutrophils
Uses
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Used in patients undergoing chemotherapy Decreases risk of infection
Adverse Effects
Bone pain, leukocytosis Elevates uric acid levels, LDH, and alkaline phosphatase Splenomegaly
GLIPIZIDE (GLUCOTROL) GLYBURIDE (MICRONASE) GLIMEPIRIDE (AMARYL) Oral Hypoglycemic Agents Sulfonylureas
GLIPIZIDE (GLUCOTROL) Oral Hypoglycemic Agent Sulfonylurea

Stimulates insulin release from the pancreas
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Uses
Type 2 diabetes
Adverse Effects Hypoglycemia Fetal harm
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METFORMIN (GLUCOPHAGE) Oral Hypoglycemic Agent Biguanide

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METFORMIN (GLUCOPHAGE) Oral Hypoglycemic Agent Biguanide

Decreases blood sugar by decreasing production of glucose in the liver Enhances glucose uptake and utilization in muscle
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) Thiazolidinediones (TZDs) Glitazones Insulin Sensitizers
ROSIGLITAZONE (AVANDIA) Thiazolidinedione (TZD) Glitazone Insulin Sensitizer

Increases insulin sensitivity
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Uses
Type 2 diabetes
Adverse Effects Fluid retentioncaution in patients with CHF Hepatotoxicitymonitor ALT
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MIGLITOL (GLYSET) ACARBOSE (PRECOSE) Alpha-Glucosidase Inhibitors Hypoglycemic Agents

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

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) Meglitinides Hypoglycemic Agents

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REPAGLINIDE (PRANDIN) NATEGLINIDE (STARLIX) Meglitinides Hypoglycemic Agents

Stimulate pancreatic insulin release
Uses
Type 2 diabetes
Adverse Effects Hypoglycemia Administer 30 minutes before meal
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GLUCAGON
GLUCAGON
Hormone that increases plasma levels of glucose Opposite effect of insulin
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Uses Treats hypoglycemia from insulin overdose Used only if IV glucose is not available
LEVOTHYROXINE (SYNTHROID, LEVOXYL) Thyroid Replacement Hormone Synthetic Preparation of T4

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LEVOTHYROXINE (SYNTHROID, LEVOXYL) Thyroid Replacement Hormone Synthetic Preparation of T4

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
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PROPYLTHIOURACIL (PTU) Antithyroid Drug
PROPYLTHIOURACIL (PTU) Antithyroid Drug

Inhibits thyroid hormone synthesis
Uses
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Hyperthyroidism, Graves disease Thyrotoxic crisis
Adverse Effects
Agranulocytosis, hypothyroidism, rash Fetal harm
GLUCOCORTICOIDS
GLUCOCORTICOIDS
Suppress immune responses and inammation Inhibit prostaglandins, leukotrienes, and histamine Suppress phagocytes and lymphocytes
Uses
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Rheumatoid arthritis, SLE, inammatory bowel disease Bursitis, osteoarthritis, anaphylaxis, asthma Skin disorders, prevention of respiratory distress syndrome (RDS) in preterm infants Replacement therapy for patients with Addisons disease
Adverse Effects
Adrenal insufciency resulting from suppression of HPA axis Glucose intolerance (increases blood sugar), osteoporosis, infection Growth retardation, mood changes, cataracts, glaucoma Peptic ulcer disease, iatrogenic Cushings syndrome
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SILDENAFIL (VIAGRA) TADALAFIL (CIALIS) VARDENAFIL (LEVITRA) Erectile Dysfunction Drugs

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SILDENAFIL (VIAGRA) Erectile Dysfunction Drug

Enhances the normal erectile response to sexual stimuli by inhibiting PDE-5
Uses
Erectile dysfunction
Adverse Effects
Hypotension, priapism, headache, and ushing Visual changes Use with nitrates and alpha blockers leads to hypotension
PRAZOSIN (MINIPRESS) Alpha-Adrenergic Antagonist Alpha Blocker

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PRAZOSIN (MINIPRESS) 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, reex tachycardia Inhibition of ejaculation Nasal congestion Use with erectile dysfunction drugs may lead to hypotension
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LIVE VIRUS VACCINES

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

Live virus vaccines are contraindicated in pregnancy Give with caution in immunocompromised patients
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CYCLOSPORINE (SANDIMMUNE) Immunosuppressant Drug
CYCLOSPORINE (SANDIMMUNE) Immunosuppressant Drug

Suppresses production of inammatory cells Decreases B cells and cytotoxic T cells
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Uses Organ transplant Adverse Effects Nephrotoxicity, infection, hepatotoxicity, lymphomas Hypertension, anaphylaxis, fetal harm
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METHOTREXATE (RHEUMATREX, TREXALL) Cytotoxic Drug Immunosuppressant Disease-Modifying Antirheumatic Drug (DMARD)
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METHOTREXATE (RHEUMATREX, TREXALL) 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-Hodgkins lymphoma Lymphocytic leukemia, psoriasis
Adverse Effects
Bone marrow suppression, hepatic brosis GI ulceration, pneumonitis, and fetal harm
DIPHENHYDRAMINE (BENADRYL) First-Generation H1 Antagonist Antihistamine

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DIPHENHYDRAMINE (BENADRYL) First-Generation H1 Antagonist Antihistamine

Blocks H1 receptors Blocks some muscarinic receptors Reduces actions of histamine Decreases ushing, 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
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LORATADINE (CLARITIN) DESLORATADINE (CLARINEX) FEXOFENADINE (ALLEGRA) CETIRIZINE (ZYRTEC)

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LORATADINE (CLARITIN) Second-Generation Nonsedating H1 Antagonist (Antihistamine)

Blocks H1 receptors Reduces actions of histamine Decreases ushing, itching, secretion of mucus Does not cross blood-brain barrier to cause sedation
Second-Generation Nonsedating H1 Antagonists (Antihistamines)
Uses Allergic rhinitis, urticaria, and mild transfusion reactions Adverse Effects
Decrease dose if hepatic or renal impairment occurs Cetirizine (Zyrtec) may cause mild sedation in some patients
ASPIRIN Antiplatelet Drug Cyclooxygenase (COX) Inhibitor First-Generation NSAID

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

Suppresses platelet aggregation by inhibiting COX-1 and COX-2 Decreases prostaglandin synthesis Reduces inammation, pain, and fever
Uses Pain, fever, inammation Prevention of thrombus in arteries Prevents MI and stroke Adverse Effects Bleeding, gastric ulceration, renal impairment Not used in children because of Reyes syndrome Fetal harm, salicylism Hypersensitivity in patients with allergies
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IBUPROFEN (ADVIL, MOTRIN) First-Generation NSAID
IBUPROFEN (ADVIL, MOTRIN) First-Generation NSAID

Inhibits cyclooxygenase (COX)-1 and COX-2 Inhibits prostaglandin synthesis Has antiinammatory, analgesic, and antipyretic actions
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Uses Dysmenorrhea, arthritis, pain, and fever Adverse Effects

Bleeding, gastric ulceration, renal impairment Cross-hypersensitivity with aspirin May precipitate Reyes syndrome, fetal harm
CELECOXIB (CELEBREX) Second-Generation NSAID COX-2 Inhibitor

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

Selective inhibition of COX-2, decreases prostaglandin synthesis (pain and inammation 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
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ACETAMINOPHEN (TYLENOL) Analgesic Antipyretic

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ACETAMINOPHEN (TYLENOL) Analgesic Antipyretic

Decreases prostaglandin synthesis in the CNS Devoid of antiinammatory 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
FLUTICASONE PROPIONATE (FLOVENT) Inhaled Corticosteroid (ICS)
FLUTICASONE PROPIONATE (FLOVENT) Inhaled Corticosteroid (ICS)

Suppresses inammation 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
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Uses Asthma Adverse Effects Oropharyngeal candidiasisrinse 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) Long-Acting Inhaled Beta2-Adrenergic Agonist
SALMETEROL (SEREVENT) Long-Acting Inhaled Beta2-Adrenergic Agonist

Activates beta2 receptors in the lung Promotes bronchodilation Suppresses histamine release in the lung Increases ciliary motility
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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) Leukotriene Modier
MONTELUKAST (SINGULAIR) Leukotriene Modier

Blocks leukotriene receptors Decreases inammation, bronchoconstriction, and edema Decreases mucous secretion Decreases eosinophils and other inammatory cells Reduces dosage of inhaled corticosteroid (ICS)
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Uses Asthma and allergic rhinitis Adverse Effects GI upset Effect is delayed
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THEOPHYLLINE Methylxanthine Bronchodilator

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THEOPHYLLINE Methylxanthine Bronchodilator

Produces bronchodilation by relaxing bronchi
Uses Asthma (beta2 agonists and corticosteroids preferred) Adverse Effects Narrow therapeutic range (5 to 10 mcg/mL) Dysrhythmias, ventricular brillation Convulsions, cardiorespiratory collapse, and death
ALBUTEROL (PROVENTIL, VENTOLIN, ACCUNEB) Beta2-Adrenergic Agonist Bronchodilator

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ALBUTEROL (PROVENTIL, VENTOLIN, ACCUNEB) 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
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RANITIDINE (ZANTAC) CIMETIDINE (TAGAMET) FAMOTIDINE (PEPCID) NIZATIDINE (AXID)

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RANITIDINE (ZANTAC) Histamine2-Receptor Antagonist

Blocks H2 receptors on parietal cells of the stomach Reduces volume of gastric juice and hydrogen ion content
Histamine2-Receptor Antagonists
Uses
Gastric and duodenal ulcers Gastroesophageal reux disease (GERD), dyspepsia Treatment of Zollinger-Ellison syndrome
Adverse Effects Signicant side effects are uncommon
OMEPRAZOLE (PRILOSEC) LANSOPRAZOLE (PREVACID) RABEPRAZOLE (ACIPHEX) PANTOPRAZOLE (PROTONIX) ESOMEPRAZOLE (NEXIUM) Proton Pump Inhibitors (PPIs)
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OMEPRAZOLE (PRILOSEC) Proton Pump Inhibitor (PPI)

Inhibits the enzyme that generates acid production
Uses Duodenal and gastric ulcers, GERD, dyspepsia Zollinger-Ellison syndrome Adverse Effects Headache, diarrhea, nausea, and vomiting
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SUCRALFATE (CARAFATE) Antiulcer drug
SUCRALFATE (CARAFATE) Antiulcer drug

Creates a protective barrier against acid and pepsin Sticky gel adheres to ulcer crater
Uses
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Duodenal and gastric ulcers
Adverse Effects
May impede the absorption of some drugs Separate at least 2 hours from other drugs
METOCLOPRAMIDE (REGLAN) Prokinetic Drug
METOCLOPRAMIDE (REGLAN) Prokinetic Drug

Reduces emesis by blocking receptors in the chemoreceptor trigger zone (CTZ) Increases upper GI motility by enhancing the actions of ACh
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Uses
Suppresses nausea caused by chemotherapy Suppresses postoperative emesis and GERD
Adverse Effects
Sedation and diarrhea Extrapyramidal reactions, especially in children
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SULFASALAZINE (AZULFIDINE) Aminosalicylate
SULFASALAZINE (AZULFIDINE) Aminosalicylate

Reduces inammation
Uses
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Inammatory bowel disease Crohns disease and ulcerative colitis
Adverse Effects
Nausea, fever, rash, and arthralgias Agranulocytosis, hemolytic anemia, and macrocytic anemia
ONDANSETRON (ZOFRAN) Antiemetic Drug Serotonin-Receptor Antagonist

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ONDANSETRON (ZOFRAN) Antiemetic Drug Serotonin-Receptor Antagonist

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
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PROCHLORPERAZINE (COMPAZINE) PROMETHAZINE (PHENERGAN) Antiemetic Drugs Dopamine Antagonists

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PROCHLORPERAZINE (COMPAZINE) Antiemetic Drug Dopamine Antagonist

Suppresses emesis by blocking dopamine2 receptors in the CTZ
Uses Nausea and vomiting Used after surgery, cancer chemotherapy, or other conditions Adverse Effects Extrapyramidal reactions, anticholinergic effects Hypotension and sedation
HYDROXYZINE (VISTARIL, ATARAX) Antiemetic Drug Anticholinergic-Antihistamine

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HYDROXYZINE (VISTARIL, ATARAX) Antiemetic Drug Anticholinergic-Antihistamine

Blocks histaminergic and cholinergic receptors
Uses
Nausea
Adverse Effects
Sedation, blurry vision, urinary retention, dry mouth
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PENICILLIN G (BENZYLPENICILLIN) Narrow-Spectrum Penicillin
PENICILLIN G (BENZYLPENICILLIN) Narrow-Spectrum Penicillin

Weakens the bacterial cell wall
Uses
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Treats Streptococcus, Neisseria, anaerobes, and others Drug of choice for syphilis
Adverse Effects
Allergic reaction, pain at site of injection Neurotoxicities
NAFCILLIN (UNIPEN) Penicillinase-Resistant Penicillin (Antistaphylococcal Penicillin)

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

Weakens the cell wall
Uses
Treats infections caused by Staphylococcus aureus
Adverse Effects
Allergic reaction, GI effects Thrombophlebitis, hypokalemia
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AMOXICILLIN (AMOXIL) Broad-Spectrum Penicillin (Aminopenicillin)
AMOXICILLIN (AMOXIL) Broad-Spectrum Penicillin (Aminopenicillin)

Uses
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Treats infections caused by Haemophilus inuenzae, Escherichia coli, Proteus mirabilis, enterococci Neisseria gonorrhoeae
Adverse Effects Diarrhea
CEFAZOLIN (KEFZOL, ANCEF) First-Generation Cephalosporin Beta-Lactam Antibiotic

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

Uses
Gram-positive infections Surgical prophylaxis
Adverse Effects Allergic reaction Bleeding tendencies Thrombophlebitis Antibiotic-associated pseudomembranous colitis (AAPMC)
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CEFUROXIME (CEFTIN) Second-Generation Cephalosporin Beta-Lactam Antibiotic

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

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) Third-Generation Cephalosporin Beta-Lactam Antibiotic

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

Uses
Active against gram-negative organisms
Adverse Effects Allergic reaction Bleeding tendencies Thrombophlebitis Antibiotic-associated pseudomembranous colitis (AAPMC)
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VANCOMYCIN (VANCOCIN) Antibiotic
VANCOMYCIN (VANCOCIN) Antibiotic

Inhibits bacterial cell wall synthesis
Uses
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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 (ushing, tachycardia, and hypotension) Infuse over 60 minutes or more Thrombophlebitis
TETRACYCLINE DOXYCYCLINE MINOCYCLINE Broad-Spectrum Antibiotics

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TETRACYCLINE Broad-Spectrum Antibiotic

Suppresses bacterial growth by inhibiting protein synthesis
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
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ERYTHROMYCIN CLARITHROMYCIN (BIAXIN) AZITHROMYCIN (ZITHROMAX) DIRITHROMYCIN (DYNABAC) TELITHROMYCIN (KETEK) Macrolide Antibiotics Broad-Spectrum Antibiotics
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ERYTHROMYCIN Macrolide Antibiotic Broad-Spectrum Antibiotic

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
CLINDAMYCIN (CLEOCIN) Antibiotic
CLINDAMYCIN (CLEOCIN) Antibiotic

Inhibits bacterial protein synthesis
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Uses Active against most anaerobic bacteria outside the CNS Bacteroides fragilis, Fusobacterium, Clostridium perfringens Adverse Effects Antibiotic-associated pseudomembranous colitis (AAPMC) Diarrhea
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GENTAMICIN (GARAMYCIN) AMIKACIN (AMIKIN) TOBRAMYCIN (NEBCIN) Aminoglycoside Antibiotics Narrow-Spectrum Antibiotics
GENTAMICIN (GARAMYCIN) Aminoglycoside Antibiotic Narrow-Spectrum Antibiotic

Disrupts bacterial protein synthesis
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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) Intensies neuromuscular blockade, leading to respiratory arrest Incompatible with PCN
TRIMETHOPRIM/SULFAMETHOXAZOLE (TMP-SMZ-BACTRIM) Antibiotic

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TRIMETHOPRIM/SULFAMETHOXAZOLE (TMP-SMZ-BACTRIM) Antibiotic

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

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CIPROFLOXACIN (CIPRO) Fluoroquinolone Antibiotic

Inhibits bacterial DNA
Uses
Fluoroquinolone Antibiotics
Infections of the urinary, respiratory, and GI tracts; bones; joints; skin; and soft tissues
Adverse Effects
GI upset, CNS effects (dizziness, headache, restlessness) Achilles tendon rupture Do not take with milk products Elevates levels of warfarin Not recommended for children under 18 years old Avoid in pregnancy
METRONIDAZOLE (FLAGYL) Antibacterial Drug
METRONIDAZOLE (FLAGYL) Antibacterial Drug

Causes cell death by damaging bacterial DNA
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Uses Protozoal infection Infections caused by obligate anaerobic bacteria Bacteroides, Clostridium difcile, 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 Disulram-like effect when used with alcohol Increases warfarin levels
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KETOCONAZOLE (NIZORAL) FLUCONAZOLE (DIFLUCAN) ITRACONAZOLE (SPORANOX) MICONAZOLE (MONISTAT) CLOTRIMAZOLE Antifungal Agents
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KETOCONAZOLE (NIZORAL) Antifungal Agent

Causes bacterial cell wall to leak
Uses
Systemic and supercial mycoses (fungi)
Adverse Effects Hepatotoxicity (monitor liver function tests [LFTs]) Decreases sex hormones Dont give with PPIs Inhibits hepatic drug-metabolizing enzymes Increases levels of warfarin, phenytoin, and some statins
GRISEOFULVIN Antifungal Agent
GRISEOFULVIN Antifungal Agent

Inhibits fungal mitosis
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Uses Supercial mycoses (fungi) Dermatophytic infections of the skin, hair, and nails Not active against Candida species or systemic mycoses May take 3 to 8 weeks to respond Adverse Effects
May decrease the effects of warfarin
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ACYCLOVIR (ZOVIRAX) VALACYCLOVIR (VALTREX) FAMCICLOVIR (FAMVIR) Antiviral Agents

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ACYCLOVIR (ZOVIRAX) Antiviral Agent

Suppresses synthesis of viral DNA
Uses
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 Antiviral Agent
INTERFERON ALPHA Antiviral Agent

Decreases viral replication
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Uses Hepatitis B and C Adverse Effects Flulike syndrome Depression Fatigue, hair loss, thyroid damage, heart damage Bone marrow suppression
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RIBAVIRIN (REBETOL) Antiviral Agent
RIBAVIRIN (REBETOL) Antiviral Agent

Uses Used with interferon for treatment of hepatitis C
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Adverse Effects Hemolytic anemia Fetal harm (Category X) Use second reliable form of birth control during treatment and 6 months after treatment
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs) Zidovudine (Retrovir) Lamivudine (Epivir) Zalcitabine (Hivid) Antiretroviral Drugs
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs) Antiretroviral Drugs

Suppress the synthesis of viral DNA by blocking transcriptase
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Uses
HIV infection
Adverse Effects
Anemia, neutropenia, lactic acidosis
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NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)

Delavirdine (Rescriptor) Efavirenz (Sustiva) Nevirapine (Viramune)
NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs) Antiretroviral Drugs

Inhibit reverse transcriptase by binding to it
Antiretroviral Drugs
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Uses HIV infection Adverse Effects Rash, Stevens-Johnson syndrome, erythema multiforme Hepatotoxicity
PROTEASE INHIBITORS
Nelnavir (Viracept) Ritonavir (Norvir) Saquinavir (Invirase)
PROTEASE INHIBITORS Antiretroviral Drugs

Inhibit the enzyme protease, needed for HIV to mature
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Antiretroviral Drugs
Uses HIV Adverse Effects

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

Functions of Peripheral Adrenergic Receptor Subtypes

Functions of Peripheral Cholinergic Receptor Subtypes

Alpha2 Beta1 Beta2

Sweat glands Sex organs Blood vessels

BETHANECHOL (URECHOLINE) Muscarinic Agonist

BETHANECHOL (URECHOLINE) Muscarinic Agonist

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

ATROPINE Muscarinic Antagonist (Anticholinergic)

ATROPINE Muscarinic Antagonist (Anticholinergic)

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

NEOSTIGMINE (PROSTIGMINE) Reversible Cholinesterase Inhibitor

NEOSTIGMINE (PROSTIGMINE) Reversible Cholinesterase Inhibitor

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

SUCCINYLCHOLINE Depolarizing Neuromuscular Blocker

SUCCINYLCHOLINE Depolarizing Neuromuscular Blocker

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

PHENYLEPHRINE Adrenergic Agonist

PHENYLEPHRINE Adrenergic Agonist

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

EPINEPHRINE Adrenergic Agonist (Catecholamine)

EPINEPHRINE Adrenergic Agonist (Catecholamine)

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

PROPRANOLOL (INDERAL) Adrenergic Antagonist Noncardioselective Beta Blocker

PROPRANOLOL (INDERAL) Adrenergic Antagonist Noncardioselective Beta Blocker

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

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

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

PRAZOSIN (MINIPRESS) Adrenergic Antagonist Alpha Blocker

PRAZOSIN (MINIPRESS) Adrenergic Antagonist Alpha blocker

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

CLONIDINE (CATAPRES) Centrally Acting Alpha2 Agonist Antihypertensive Drug

CLONIDINE (CATAPRES) Centrally Acting Alpha2 Agonist Antihypertensive Drug

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

LEVODOPA/CARBIDOPA (SINEMET) Dopaminergic Agent

LEVODOPA/CARBIDOPA (SINEMET) Dopaminergic Agent

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

DONEPEZIL (ARICEPT) Cholinesterase Inhibitor

DONEPEZIL (ARICEPT) Cholinesterase Inhibitor

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

PHENYTOIN (DILANTIN) Antiepileptic Drug (AED)

PHENYTOIN (DILANTIN) Antiepileptic Drug (AED)

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

VALPROIC ACID (DEPAKOTE) Antiepileptic Drug (AED)

VALPROIC ACID (DEPAKOTE) Antiepileptic Drug (AED)

Uses Epilepsy, bipolar disorder, migraine headaches Adverse Effects

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

MORPHINE Opioid Analgesic

MORPHINE Opioid Analgesic

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

NALOXONE (NARCAN) Opioid Antagonist

NALOXONE (NARCAN) Opioid Antagonist

Opioid overdose Reversal of excessive respiratory depression

Adverse Effects Minimal

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

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

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

Adverse Effects Chest pressure, coronary vasospasm Fetal harm

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)

CONVENTIONAL ANTIPSYCHOTICS (NEUROLEPTICS)

Copyright 2007 by Saunders, an imprint of Elsevier Inc.

Uses Schizophrenia Adverse Effects

Copyright 2007 by Saunders, an imprint of Elsevier Inc.