Pharm-drugs Charts

7/26/2019 Pharm-drugs Charts

1/21

Drug Name Category s/s Pt teaching

Albuterol- rescue

Salmeterol- long term

2agonists

Bronchodilators

Increased HR, tremors,

insomnia, tolerance,

hypokalemia

How/when to appropri-

ately take. Albuterol is

rescue only

Ipratropium (Atrovent)-

shorter

Tiotropium (Sprivia)-long acting

Anti-cholinergics

Bronchodilators

Block PSS- antagonist ofacetylcholine

Dry mouth, constipa-

tion(rare if inhaled)

Theophylline Xanthines

Bronchodilators

Inhibit phos-

phodieserase enzyme

Irritability, restless ness,

GI, Cardiac stimulation

(increased HR, arrhyth-

mias) CNS stimulation

(excitability, insomnia,

seizures)

Serum drug monitoring,

smokers metabolize

faster,COPD mainte-

nance, narrow therapeu-

tic window

BAD DRUG

Fluticasone(Flovent)

long term inhaledBudesonide (Pulmicort)-

long term inhaled

Corticosteriods

Anti-inflammatory

Oropharyngeal candidia-

sis,Sore throat

Advise pt to rinse mouth

after use

Montelukast (singular) Leukotriene Modifiers

Anti-inflammatory

Selectively antagonize

receptor for production

of leukotrienes- allergies

Pseudoephedrine (Su-

dafed)

Phenylephrine

Oral decongestants

Decreases blood flow to

capillaries causing

shrinking of nasal pas-

sages

Cardiac stimulation,

restlessness, insomnia,

tremors

Precautions in preg-

nancy, HTN, cardiac pts.

(Controlled substance

due to meth production)

Diphenhydramine (Ben-

adryl)- 1stgen

Loratadine (Claritin,

Alavert)- 2ndgen

Anti-histamines

H1 blockers

Sedation, drying

Less so with 2ndgen

Dextromethorphan(Delsym, Robitussin

DM)

Anti-tussiveCentrally acting through

medulla to suppress

cough

Sedation, dry mouth

Guafenesin (Robitussin,

Mucinex)

Expectorants

Thin secretions

GI

Respiratory Drugs ^


2/21

ANS DrugsAlpha/Beta drugs

Drug Name Category S/S Uses

Epinephrine Alpha1/2 and beta 1/2 adrenergic ag-

onist

BP/HR/contractility/bronchodilationAt higher doses- increases HR/O2 con-

sumption

MAP

Ventricular ar-

rhythmias, HTN,

angina, hypergly-cemia(use insulin

drip)

anaphylaxis

Norephinephrine

(No rep: No respi-

ration: No lungs

(No B2)

Alpha 1/2 and Beta 1 agonist

Beta 1 effects dominate at low doses

Alpha effects dominate at high doses

Powerful vasoconstrictor that wont

stress heart

Septic shock- BP

with less tachycardia

Dobutamine

(Sounds like lub-

dub-dob=just your

heart)

B1 agonist- INOTROPE

HR,contractibility conduction

through AV node

Continuous cardiac monitoring

Heart failure

Cardiogenic shock

Phenylephrine

Phena1 Alpha

Alpha 1 agonist

Pure vasoconstrictor

(also an oral decongestant)

For pts who cannot

tolerate Beta effects

or when pure vaso-

constriction required

Used post op w/ pts

w/ low SVR

Cholinergic Agents

Drug Category s/s and cautions uses

Bethanechol Direct cholinergic ago-

nist

Increases bladder tone

and urinary excretion

N/V cramps, diarrhea,

salivation, bradycardia,

hypotension, flushing,

diaphoresis

Use sparingly due to sys-

temic PS effects and in

pts. with respiratory dis-

ease or bradycardia

Treats/prevents UTI

GERD in infants


3/21

Neostigmine/

physostigmine

Indirect cholinergic ago-

nist

Myasthenia Gravis-

chronic muscular dis-

ease results in destruc-

tion of Ach receptors

Donepezil

(I want Alzheimersdis-

ease to be DONE with!)

Indirect cholinergic ago-

nist

Alzheimers Disease- pro-

gressive loss of Ach pro-

ducing neurons

Atropine ANTI-cholinergic

Relaxes GI tract, inhibits

GI secretions

Bradycardia, dilate pu-

pils, prior to surgery

Antibiotics

Drug Action Category Name Notes

Blocks cell wall

synthesis

Beta-Lactams

Penicillins

Penicillin (syphilis/dental)

Amoxicillin

Amoxicillin-Clavulante (Augmen-

tin)(beta-lactamase inhibitor)

Nafcillin (MSSA/skin infections)Methicillin-sensitive Staphylococcus aureus

Not active against MRSA

GI side effects/rash

PCN combinations like Aug-

mentin for betalactamase

inhibitor

Blocks cell wall

synthesis

Beta-Lactams

Cephalosporins

Cefazolin (1stgen)

Cephalexin (1stgen) (Glenn)

Cefoxitin (2ndgen)

Ceftriaxone (3rdgen): cleared by liver(not kidney like the rest of them)

Cefepime (4thgen)(As you go up the generations (1, 2, 3, 4)

your gram negative coverage increases)

1stgen- surgery prophylaxis/

skin infection

-Res tract infections

3/4 for CNS can cross BBB

GI/bleeding and effective

for menengitis

(For ones cleared by the kidneys-

you need to adjust the dose or

they may get seizures)

Blocks cell wall

synthesis

Beta-Lactams

Carbapenems

Imipenem

Meropenem

Broadest spectrum, often

used 1stand for mixed infec-

tions, can lower seizure

threshold

Blocks cell wall

synthesis

Glycopeptide Vancomycin Gram + only

MRSANo cross between PO and IV

Nephro/ototoxicity

Red manssyndrome (they

feel allergy but arent:prob b/c

of rate of infusion)

Dosed via pharmakinetics

PO: CANTbe used to treat sys-

temic infections (MRSA)


4/21


Protein Synthesis

inhibitors

Aminoglycosides Gentamicin

Tobramycin

Nephro/ototoxicity esp. with vancomycin

Gram bacteria (Pseudomonas)

Dontmix w/ PCN in IV

Protein Synthesis

inhibitors

Tetracyclines Doxycycline

Minocycline

Gram +/-, atypical pathogens

Acne, respiratory, lymes, STDs,

Photosensitivity, teeth straining, bone

growth retardation,

Oral absorption effected by milk/antacids

No children/pregnancies

Protein Synthesis

inhibitors

Macrolides Erythromycin

Azithromycin (Z-pack)

Gram +/-, atypical pathogens

Respiratory, STDs, Chlamydia, MAC infec-

tions (AIDS)

MAJOR GI UPSET

CYP450 inhibitor

Protein Synthesis

inhibitors

Clindamycin Gram +,Anaerobes

Cellulitis w/ PCN allergies

TSS

Osteomyelitis- bone penetration

s/s GI , C. diff

Protein Synthesis Inhibitors:bind to either 30S or 50S ribosomal unit and interfere with tran-

scription of mRNA into protein


Disrupts DNA

structure- CIDAL

Nitromidazoles Metronidazole

(Flagyl)

Gram +/- anaerobes only

Treats C. diff

Major reaction with alcohol

Inhibit DNA tran-

scription in mRNA

and protein

TB drugs Rifampin Red discoloration of bodily fluids, hepa-

totoxic, GI side effects

Inducer of CYP450

Isoianzid (INH) Hepatotoxic, peripheral neuropathy (pre-

vented with vitamin B6)

Inhibit DNA syn-

thesis by inhibit-

ing DNA gyrase-

CIDAL

Fluroquinolones

(FQs)(most over-used antibiotic in US)

Ciprofloxacin (older:better gram-(-) coverage,

weak gram (-) activity)

Levofloxacin &

Moxifloxacin (Newer:enhanced gram-(+) activity

& anaerobes)

Pneumonia, UTI, great bone penetration,

travelersdiarrhea(cipro) Mixed infec-

tions (mox)

S/s GI, hyperglycemia, Achilles tendon

rupture, Prolonged QT

Caution with kids (CF pts. use)

CYP450 inhibitor


5/21

Elderly do not tolerate well

Block incorpora-

tion of PABA

Sulfas TMP-SMX

sulfadiazine

Gram +/-

Inflammatory bowel disease, UTI, acute

otitis media, some MRSA

S/S rash/GI

Photosensitivity, increase fluid intake

Anti-Viral Agents


Inhibit viral DNA

replication

Agents for Herpes Acyclovir (Zovirax) Poor bioavailability; given up to q5

Famciclovir (Famvir) Improved bioavailability; given BID to TID

Inhibit DNA syn-

thesis by inhibit-

ing DNA gyrase-

CIDAL

Agents for CMV

(cytomegalovirus)

Ganciclovir (Cy-

tovene)

PO availability low; also given IV

Biggest issue: bone marrow suppression


6/21

Inhibits activity of

enzyme

Anti-flu Tamiflu

Inhibits enzyme

that synthesizesHIV DNA (thus

preventing viral

DNA from form-

ing)

Anti-retroviral Zidovudine Used for treatment of HIV/AIDS infection

-1st

U.S. govtapproved treatment for HIV

Anti-Fungal Agents


Forms tube in cell

membrane that

drains ions

Amphotericin B Used IV for systemic fungal infections

(Amphotericin A doesntdo shit for fungal in-

fections)

Interferes with

fungal synthesis

Ketoconazole

Used PO to treat fungal infections (i.e.

tinea) and dandruff

Ketoconazole has been used as a treat-

ment for androgen-dependent prostate

cancer

Exam 2

Cardiovascular Drugs

Drug Name Class/precautions How does it work? Uses and S/S

Atenolol (Tenormin)

Metoprolol (Lopressor,

Toprol XL)

Propranolol (Inderal)

Beta blockers

-selective

-selective-nonselective

Block effects of SNS by

binding to beta receptor

B1- lowers HR, contractil-

ity, lowers renin release

B2- bronchoconstriction

Uses: HTN, angina, ar-

rhythmias, AMI core

measure, CHF, Migraineprophylaxis, performance

anxiety

**selective for respiratory

diseases

S/Slow HR/BP, dysrhyth-

mias (affecting conduc-

tion);AV block, impo-

tence

Precautions: may mask

symptoms of hypoglyce-

mia, must taper,


7/21

Spironolactone [Aldac-

tone]

nonselective synthetic

steroid; also binds some

androgen receptors

Eplerenone [Inspra]

selective

Aldosterone

Antagonists

Potassium Sparing Diu-

retic

someone who gets this is

started on an ACE or

some other drugs and is

looking to get more of a

hormonal blockade

Block receptors for

aldosterone

Uses: HTN, HF

S/S: Hyperkalemia [care-

ful with salt substitutes]

Gynecomastia, hir-

sutism [spironolactone]

Enalapril (Vasotec)

IV

Ramipril (Altace)

HF

Captopril (Capoten)

Not a prodrug

Shortest half life

ACE inhibitors

-precautions with bilat-

eral renal artery stenosis,

pregnancy

-less effective with Afri-

can Americans

-monitor BP, SCr, K+

-ACE escape

-Suppress RAAS

- blocks conversion of An-

giotensin 1 to 2 (2 is a

vasoconstrictor)

-blocks degradation of

bradykinin (dilator)->

causes angioedema

Uses:

-reduces systemic vascu-

lar resistance- HTN

-prevents renal failure in

diabetics( diabetic neu-

ropathy)

-prevents vascular re-

modeling (MI, AMI core

measure)-prevents progression of

heart failure (CHF, core

measure)

S/S--dizziness, orthos-

tatic hypertension, GI dis-

tress, nonproductive

cough, headache, hyper-

kalemia(potassium in-

versely related to aldoste-

rone)

-all excreted by kidney

-prodrugs: convert to ac-

tive form in liver-reduced absorption with

food except enalapril

Losartan (Cozaar)

HF

Valsartan (Diovan)

ARBS

startansBlocks the effects of angi-

otensin II by preventing

binding to receptors

Uses: HTN, CHF,Diabetic

nephropathy, MI

S/S: hypotension, acute

renal failure in B/L

RAS(renal), fetal injury

Clonidine (Catapres)

lowers CO

Methyldopa (Aldomet)(HTN in Pregnancy)

HTN/vasodilates

Hepatic injury

Alpha 2- agonist Act within the brainstem

to suppress sympathetic

outflow to the heart and

blood vessels: vasodila-tion,

Uses: HTN(methyldopa),

chronic pain, menopausal

symptoms, withdrawal

from opioidsS/S dry mouth, sedation,

low BP, rebound HTN,

slow taperPositiveCoombstest and hemo-

lytic anemia


8/21

Terazosin (Hytrin)

Tamsulosin (Flomax)

(wontaffect BP, not sys-

temic)

Alpha 1 blockers

Adrenergic DrugsPrevents stimulation of

a1 receptors on vessels,

resulting in vasodilation.

1. Dilate arteries, veins

2. Relaxes smooth muscle

in bladder neck and pros-

tate.

Uses: HTNwith BPH,not

for HTN alone.

S/S: orthostatic hypoten-

sion, dizziness/drowsi-

ness, vivid dreams

Warn of 1st dose or-

thostasis;admin at bed-

time,slow titration of

doses.

Do not take with Viagra(increased risk of hypo-

tension)

Nifedipine(Procardia)

(gingival hyperplasia)

Amlodipine (Norvasc)

CC Blockers

(Calcium antagonists)

Dihydropyridines- pri-

marily vasodilates

-P450 and Grapefruit

juice

-Betas

-Dig

Not for use in CHF

Prevents Ca++ from en-

tering cell at

1. vascular smooth mus-

cle-> vasodilation

Uses: HTN, Angina,

S/S: reflex tachycardia

Flushing, edema, heach-

ache, dizziness, hypoten-

sion, gingival hyperplasia

(nifedipine)

Verapamil(Calan, Verela)(Constipation)

Diltiazem(Cardizem)

CC Blockers

(Calcium antagonists)

non-Dihydropyridines-

effect on cardiac conduc-

tion

-P450 and Grapefruit

juice

-Betas

-Dig

Not for use in CHF

Prevents Ca++ from en-

tering cell at

1. vascular smooth mus-

cle-> vasodilation

2. heart -> lowers HR (SA

node) and conduction

(AV node)

OD- Treat w IV Ca

Uses: HTN, Angina, Ar-

rythmias

S/S:

Lowers HR,AV block,

Constipation

Flushing, edema, heach-

ache, dizziness, hypoten-

sion

Sodium Nitroprusside(Nitropress) VasodilatorDiuretic 394

Narrow therapeutic index

BP via vasodilationwhen administered IV in-

fusion.

OD- Treat w IV Ca

Uses: HTN emergencies(diastolic >120)

S/S: flushing, profound

hypotension, H/A, dizzi-

ness, reflex tachycardia

Cyanide poisoning with

prolonged use(>72hrs)

-CNS effects, delirium

-monitor levels of theocy-

anate

Nitroglycerin (Nitro-Bid,

Nitrostat) (rapid)

Isosorbide mononitrate

(Imdur)

Nitrodur patches

(long)

Nitrates pg 369-371

Precautions:

Drug allergySevere anemia

Closed angle glaucoma

Hypotension and

Severe head injury

Deaths reported w drug

interactions of meds for

erectile dysfunction

Relax vascular smooth

muscle via stimulation of

intracellular GMP1. reduce myocardial de-

mand by decreasing pre-

load

Effects: Major dilation of

venous bed1. work on heart

2. does NOT affect cardiac

function

Uses: rapid acting- first

line for acute attacks, to

treat stable, unstable vas-ospastic angina

Long acting- maintenance

or prevention of angina

SS: Headache tachycar-

dia(REFLEX TACHYCAR-

DIA) postural hypoten-

sion

Topical- contact derititis


9/21

Digoxin-BAD DRUG Cardiac GlycosidesMechanical and electrical

effects on the heart

Positive inotrope- im-

prove force of contraction

Negative chronotrope-

decreases conductivity

Inhibits sodium potas-

sium pump resulting in

increased calcium accu-

mulation

Uses:Arrhythmias, CHF

S/S GI symptoms (first

sign), arrhythmias, head-

ache, yellow halo,

blurred vision

Predisposing factors to

cardiac toxicity: hypoka-

lemia (diuretics),

Heart disease, elevated

digoxin levelsTarget level 0.7-1.2

Do EKG for toxicity pts

Antidote- digibind

Milrinone (Primacor) No class Phosphodieesterase in-hibitor acts as a cardio-

tonic or inotropic agent

Blocking phos-

phodiesterase enzyme

calcium in cells, leading

to stronger contraction

in cardiac muscle

Uses: short term for pts

who have decompensated

these pts are waiting for

heart transplants etc

on these drugs bc we

have nothing left

S/S ventricular arrhyth-

mias, hypotension, GIReally only use in last

stage of HF

Anticoagulants

Name Class Precautions/monitor S/S

Heparin

Intrinsic

overdose treat-

ing with protamine sul-

fate

Anticoagulant- prevents

or retards formulation of

new thrombi

PTT/CBC with platelets-

only IV (link between

long term therapy and os-

teoporosis

Hematuria, GI bleeding,

hemoptysis, thrombocy-

topenia (loewplatlets)

Enoxaparin (Lovenox)-

LMWHAnticoagulant- prevents


new thrombi

No test for monitoring,

only given sub-q, pre-

measured doses


hemoptysis, thrombocy-

topenia less likely than

heparin

Warfarin (coumidin)

-vitamin K antidote

promotes synthesis offactors only for INR over

5, can develop resistance

if vitamin K is still in sys-

tem

Anticoagulant-prevents


new thrombi-Does not provide instant

protection 2-3 days of

heparin needed in addi-

tion if treating DVT

-blocks vitamin K binding

sites and inhibits synthe-

sis of vitamin K depend-

ent factors and proteins

CNS

Teratogenic- cross BBB

INR

-maintain fixed intake of

vitamin K-extensive interaction

with P450 system

Minor bruising or bleed-

ing, nasal mucosal, major

GI bleeding, hematuria,teratogenic!


10/21

Streptokinase Thrombolytic:DISSOLVEblood clot at site of injury

by activating plasmino-

gen to plasmin which di-

gests the clot and coagu-

lation factors.

Not to be used if brain in-

jury or hemorrhage, or

with uncontrolled HTN.

Must be given 3-6 hrs of

symptoms. Intracerebral

hemorrhage is a MAJOR

complicatin.

Uses: Acute MI, PE, is-

chemic cardiovascular

events.

Door to needle time

30mins

Aspirin Antiplatelets- prevents

platelet aggregation byinhibiting cyclooxygenase

in platelets

Uses: prevent stroke, MI,

CV deathS/S dose/duration re-

lated, GI disturbances,

bleeding, discontinue

prior to procedures

Plavix Antiplatelets- preventsplatelet aggregation by

inhibiting binding of ADP

to platelet receptor, used

if allergy to ASA

-needs to be activated by

TC19 enzyme

Uses: prevent stroke, MI,

CV death

S/S dose/duration re-

lated, GI disturbances,

bleeding, discontinue

prior to procedures

Dyslipidemia Agents/Cholesterol/Triglycerides

Name Class How does it work? S/S and uses

Niacin(Niaspan-SR)

Niacin

Acts on hormone sensi-

tive lipase that leads toinhibition of free fatty

acids from adipose tis-

sue

Primary effect HDLsand TG

Primary focus is to in-crease HDL

S/Sfacial flushing

(blunted with ASA admin-

istration, slow dose titra-tion, tolerance over time),

GI

Precautions:liver tox-

icity, impairs glucose tol-

erance, increases uric

acid levels,increased risk

of rhabdomylysis when

used with statins

Ezetimibe(Zetia)(Prince)

Selective Cholesterol

Absorption Inhibitors

Selectively inhibits ab-

sorptions of cholesterolfrom dietary and biliary

sources

LDL/TG

HDL used as monother-

apy or in combination

with statins (up to 50%reduction in LDL)

S/S headache, diarrhea

Precautions: check LFTs

(liver function test) if in

combo w statins


11/21

Colestipol (Colestid) Bile Acid SequestrantsAnion-exchange resins

bind to bile acids in intes-

tinal lumen, form insolu-

ble complexes, allow for

increased secretion of

bile acids, not systemi-

cally absorbed

LEAST EFFECTIVE

More cholesterol circu-

lating for conversion tobile acids

Increased catabolismof LDL by live

Uses: more cholesterol

circulating for conversion

to bile acids, increased ca-

tabolism of LDL by liver

S/Sbloating, constipa-

tion, nausea precautions:

interferes with other

drugs- by binding with

them

administer 1 hr beforeor 3-4 hrs after

Fenofibrate (Tricor)

Gemfibrozil (Lopid)Fibric Acid Derivatives

Precise mechanism un-

known

lower triglycerides and

boost HDL

for the families that

have hypertriglycer-

idemia

TG concentrations

HDLminimal effect on LDL

S/S dyspepsia, Hepato-

toxicity

MonitorLFTs

Increases risk rhabdomy-

olysis when used with

statin

Atorvastatin [Lipitor](most effective)

Simvastatin [Zocor]

Pravastatin [Pravachol]

(not metabolized by

CYP450, used by pts

with transplants/HIV)

HMG-CoA Reductase In-hibitors (statins)

Inhibit enzymes neces-

sary for precursor of cho-

lesterol ONLY DRUGSTHAT DIRECTLY WORK

ON THE CHOLESTERAL

PATHWAY

-block that enzyme that

prevents the conversion

to Mevalonate- cutting

out the cholesterol path-

way

LDL/TGHDL

primary focus is LDL

NO GRAPEFRUIT JUICE!S/SGI headache, photo-

sensitivity

MonitorLFTs, serum Cr,

CPK

Precautions: myopathy,

and rhabdo, restricted to

80mg due to risk

Hepatoxicity Contraindicated in active

liver disease

Take in the evening

Isosorbide mononitrate

[Imdur]

longest acting PO

agent, once daily

Transdermal [NitroDur]

Nitrates (NTG)

Relax vascular smooth

muscle via stimulation of

intracellular GMP

Reduce myocardial de-

mand by decreasing pre-

load

Effects: Major dilation of

venous bed

Decrease work on heartDoes notaffect cardiacfunction (HR or contracti-

bility)

LONG ACTING

Maintenance or preven-

tion of future anginal at-

tacks

S/SPostural hypotension,headache, dizziness, re-

flex tachycardia, cutane-

ous vasodilation with

flushing

Precautions:Tolerance (need nitrate-free period) -NITRODUR

Withdrawal when ab-

rupt discontinuation

Rebound HTN and an-

ginaDo not carry close tobody; keep in cool place

Drug interactions (otherdilators)

Dysrhythmic AgentsName Class & Precautions How Does it work S/E and Uses


12/21

Quinidine

Procainamide

SLE syndrome

Class Ia

Proteinbound

Drug interaction with digoxin

[displaces digoxin from albu-

min]

Work Block Na+ channels in

cell membrane during action

potential

- Affect Phase 0during the

Action Potential-Blocks the

Na channels

Strongly anticholinergic

(blocks inhibit parasympatic

NS);

ventr rate [pretreat with BB

or CCB]

Widens QRS and prolongs

QT

Uses: Afib, premature atrial

contractions, premature ven-

tricular contractions, ventric-

ular tachycardia and Wolf-

Parkinson-White Syndrome

S/E:Hypotension,

QRS > 50% prolongation,GI symptoms, Cinchonism

blurred vision, tinnitusAlbumin bound- not good w

dig

Prototype SE

Not seen a lot due to bone

marrow suppression

Lidocaine Class Ib Agent Work Block Na+ channels incell membrane during action

potential

Affect Phase 0during the

Action Potential- Blocks the

Na channels

Differs from Ia [accelerates

repolarization]

Uses: Ventricular dysrhyth-

mias only(premature ventric-

ular contractions, ventricular

tachycardia, Vfib)

Short term IV for ventricu-

lar arrhythmia

SE

Metallic taste, slurred

speech, Convulsions CNSeffects(Agitation, Anxiety,

Seizures)

Little or no effect on EKG

Flecainide [Tambocor]

Propafenone

PO AgentUsed for ventricular ar-

rhythmias or paroxysmalatrial tachycardia

BAD DRUGS

Class Ic

Generally not used in current

clinical practice due to CAST

data and better agents

Work Block Na+ channels in

cell membrane during action

potential

- Affect Phase 0during the

Action Potential- Blocks the

Na channels

Uses:

Severe ventricular

tachycardia and supra-

ventricular tachycardia

dysrhythmias, Afib and flut-

ter andWolf-Parkinson-

White Syndrome

ventricular arrhythmias or

paroxysmal atrial tachy-

cardia

SE:

risk of death

Propranolol[Inderal]Non-selective

PO Treatment of HTN, an-

gina, migraine prophylaxis

(MOST COMMON)

Esmolol [Brevibloc]Selective

IV agent with short t1/2 Im-

mediate control of SVTs and

tachycardia

Acebutolol [Sectral]Selective

PO agent; Treatment of HTN

and PVCs

Beta Blocker

Class II

Cautions:

Pre-existing bradycardia

CHF, asthma, COPD

automaticity at SA node

conduction velocity at AV

node

contractility

Affects Phase 4 ofthe Action

Potential-decreases spontane-

ous depolarization

Uses:

Treatment of SVTs

and PVCs [supraventricular

tachycardias; premature ven-

tricular contractions]

SECNS [dizziness, drowsi-

ness]

CV [BP, HR]

AmiodaronePO, IV for atrial/ventr ar-

rhythmias Drug of choice

Class III Block K+ channels; prolong

phase 3; prolong repolariza-

tion

Uses:Life ThreateningVentricular tachycardia of fi-

brillation


13/21

(afib emg) for ACLS treat-

ment of ventricular arrhyth-

mia

Dofetilide[Tikosyn]PO Conversion of Afib to

NSR; maintenance of NSR Cr

Cl calculation important-need

to be supervised while treated

Ibutilide [Corvert]IV Rapid conversion of Afib

of recent onset < 90 days-

need to be supervised while

treated

Bretylium IM,IV Short-term treatment of

ventricular arrhythmias when

others fail

Cautions:When used in

presence of hypotension or

shockProlong QT interval

CYP450 3A4 interactions

with amiodarone; t1/2

amiodarone 25 -110 days

SE:

-Prolonged OT interval-Hypotension, CHFGI

Pulmonary toxicity, skin

discoloration (BLUE), thy-

roid[amiodarone]

Diltiazem

Verapamil

Class IV

Ca Channel Blockers

Non-Dihydropyridines

Cautions: digoxin, BB

How they work: Block Ca++

channels in cell membrane



node contractility

Uses: to slow ventr rate in

Afib or terminate SVTs

SE: BP, HR, constipa-

tion, AV block

Adenosine Other How it works:



node

Uses:

Treatment of paroxys-

mal SVTs or WPW syn-

drome

T1/2 1.5 to 10 secs.ad-

ministered IV bolus as close

to the heart as possible

SE flushing, dyspnea, hypo-tension

Diuretics

Name Class How does it work? S/S and uses

Hydrochlorothiazide

(HCTZ) (HydroDiuri)

Chlorthalidone

(Hygroton)

Thiazide Diuretics

(belong to chemical class

sulfonamides)

Precautions:

Dontuse if pregnant.risk of digoxin toxicity

(b/c of K levels).

DM and gout

Caution inpt w/ DM,

gout or sulfa allergy.

Block chloride pump in

early distal convoluted

tubule.

Na, Cl, K and minor lossin water.

levels of uric acid andglucose

*Small dosage range

Uses: Mild diuretics. Uncom-

plicated HTN.

S/S:

Hypotension & dehydra-

tion-dizziness, lightheadedness

Hypokalemia

- watch for weakness, muscle

cramps, arrhythmias rare

at doses use

Hyponatremia (watch w/pt

on lithium)

Hyperglycemia. And gout (at

higher doses)


14/21

Acetazolamide (Diamox) Carbonic anhydrase in-

hibitors

Cautions:

Patients with sulfa al-lerg

Work to block formation

of carbonic acid and bi-

carbonate in renal tubule

Inhibit enzyme, car-

bonic anhydrase, results

in decreased secretion of

aqueous humor of eye

Also slow down move-ment of hydrogen so

more sodium and bicar-

bonate are lost in urine

Uses: Mild diuretics used

most often totreat glau-

coma

Not used clinically to treat

HTN or edema

S/S

metabolic acidosis [loss of

bicarb];

hypokalemia

Furosemide

(Lasix)

Bumetanide

(Bumex)

Loop Diuretics

Precautions

-Take in the morning

-Monitor bp,

-Caution for postural

hypotension.

-Consume K rich foods.

Work in loop of Henle.

Large loss of water, Na

and K. Most potent diu-

retic.

*very large dosage range

Most potent diuretic used

in ACUTE SETTINGS

Uses: Acute PE, CHFand

edema.

Esp useful in pts w/ renal

failure.

S/S:

Hypotension

-dizziness, lightheadeness

Dehydration-dry mouth,scanty urine

output

Hypokalemia,

Ototoxicity (increase risk

if pt on aminoglycoside(an-

tibiotics))

Hyperglycemia is not com-

mon.


15/21

Triamterene (Dyrenium)

( Acts more quickly.

Non aldosterone antagonist

Direct decrease in ion

transport,

Uses:HTN, edema)

Spironolactone

(Aldactone)

(More chronic use-sloweronset- 48hrs.

Aldosterone antagonist

Affects ions by blocking ac-

tion of aldosterone in distal

nephron

Uses:HTN, Heart failure,edema, primary hyperal-

dosteronism)

Potassium-sparing Diu-

retics

(Aldosterone Inhibiting)

Act to spare K in ex-

change for loss of Na and

water in urine.

Used in combination

with thiazides or loops

Rarely used alone b/climited diuresis

Corrects K+ loss of

other diuretics

FYI: never combine w/K

supplements, ACEi, or

other K sparring diuretics.

Uses: HTN, edema, (Spirono-

lactone is also used for HF

and primary hyperaldoste-

ronism.)

-Preferred ifK loss is dan-

gerous (digoxinor arrhyth-

mias).

Rarely used aloneb/c lim-

ited dieresis. Used with thia-

zides or loopsb/c it correctstheir loss of K.

S/S: Hyperkamemia,

gynecomastia, hirsutism

(spironolactone),

blue urine(Triamterene)

Mannitol (Osmitrol) Osmotic Diuretics

Precautions:

HypersensitivityAnuria

Severe dyhydration

Pulmonary congestion

Cerebral hemmhage

May crystalize when ex-

posed to low temps

-should always be admin-

istered IV through a filter

-vials stored in warmer

pharmacy

-B4 administration vial

should be inspected forprecipitants

Use hypertonic pull to re-

move fluid from intravas-

cular spaces and deliver

large amounts of fluidinto renal tubule.

Drug is highly controlled

usually in ICU settings.

Uses:

(IV) Decrease ICP, prevent

renal failure, decrease intra-

ocular pressure, and pro-mote movement of toxic sub-

stance through kidney. Drug

intoxication (to induce diu-

resis)

S/S: sudden drop in fluid lev-

els, hypotension, electrolyte

imbalances.

Anemias

Drug name Class & how it works What it is used for S/S and precautions

Darbepoetin (Aranesp)*Long acting

Epoetin (Procrit, Epogen)

Recombinant hormone:Stimulate production of

RBCsin bone marrow.

Goal of drug is to get Hgb

12g/dL.

Anemia associated withCKD. Administered SC or

IV.

Is abused and used to

raise RBCs higher than

needed to prevent fa-

tigue

Pts should receive iron sup-plements. May take 6 weeks

to see effects. Used to re-

duce need for transfusion

only.

S/S: Hypertension, head-

ache, edema, fatigue, HF, ar-

rhythmias.

IN NEWS: if abused may

cause blood clots and spur

tumor growth!


16/21

Ferrous sulfate Iron Salt: Iron entersbloodstream and is trans-

ported to liver, spleen,

bone marrow where it be-

comes part of iron stores.

Treatment of iron defi-

ciency in anemiaS/S: GI (constipation, black

feces)- titrate up to goal

dose to build up tolerance.

Take w/stool softener. Can

take with food but will bi-

oavailability.

IV: Associated w severe Hy-

persentivity reactions

Interactions:

-antibiotics absorption

-acidic environment

absorption

-Vitamin C absorption

Cyanocobalamin (Nasco-

bal) (Vitamin B)Water soluble vitamin:

Available as nasal gel given

once weekly and 100mcg

IM/SC for 1 week then ti-

trated to monthly.

Vitamin B12 deficiency.

Used when deficiency is

due to malabsorption.

Clinical improvement is in-

creased alertness, appetite

and cooperation. Hct in-

creases within 2 months.

Lifelong therapy.

CV IIIDrug Name Class & Precautions How it works Uses and SE

eparinfractionated, Conventional

rge molecule)

eatment of od/excess

th protamine sulfate

Anticoagulants

Precautions:

-Monitor aPTT [IV therapy]

-Monitor CBC with plate-

lets (thrombocytopenia)

[IV therapy]Long-term

therapy and osteoporosis

Binds toantithrombin IIIand inactivates a number

of factors (see slide)

Inactivates intrinsic path-

way

Inhibits conversion of

prothrombin to thrombin

and fibrinogen to fibrin

USES:Stroke, MI, DVT, PE, LV

thrombus (AFib)

-Prevents or retards for-

mation of new thrombi

-Prevents worsening of

thrombi damage

-allows almost instantane-

ous action

-SQ-Trying to preventclots

-IV- treating a clot

SE:Hematuria, GI bleed-

ing, hemoptysis Thrombo-

cytopenia

w-molecular weight hepa-

s (LMWH)

oxaparin (lovenox)

maller molecule

Anticoagulants

Monitoring:

Routine aPTT not neces-

saryCBC with platelets peri-

odically

Products vary based on

size,anti-Xa activity, in-

dications and dosage regi-

mens

NOT considered thera-peutically interchangeable

Enoxaparin (lovenox)

has been most widely used

-Check factor 10 A

USES:

Surgery prophylaxis, DVTs,

PE

SE:Same as UFH but >likely


hemoptysis

Hemorrhage, thrombo-

cytopeni

Warfarin [Coumadin]

itamin K is the antidote

When INR >5

Not for and acute situa-

tions

Oral anticoagulants

The only one in the US

Precautions

Blocks vitamin K-binding

sites and inhibits synthe-

sis of vitamin K-depend-

ent factors(2, 7, 9, 10) and

proteins C and S

USES:

Prevent extension of existing

thrombus and formation of

new thrombi


17/21

Narrow therapeutic index

drug

Monitor INR (goal deter-

mined by indication for use)

and CBC with platelets

Maintain fixed intake of

Vitamin K [avoid binging on

green, leafy vegetables]

EXTENSIVE drug interac-

tions with P450Discontinuation prior to

procedure

-DO NOT USE WHILE PREG-

NANT

Dosage adjusted by INR

levels [general goal is 2-3]

-takes 72 hr for onset of ac-

tion

Will NOTaffect existing

clotting factors

Stops production of NEW

clotting factors ONLY

Given PO once daily [long

half-life]

SE:Minor bruising or bleeding is

common [oral, nasal mucosa]

Major bleeding (GI, hema-

turia, hemoptysis) Terato-

genic!

Vitamin K (pg)

Phytonadione

(Vitmain K1)

Aquamephyton

(Vitmain K1)

Vitamin Promotes synthesis of

clotting factors 2, 7, 9,

10

USES:

Reversal of bleeding due

to warfarin overdose

-PO dose depends upon

INR level (>5)

SE:

Difficult to overcome re-

sistance after large doses

of Vit K administered

-making it hard to reiniti-

ate warfarin therapy

Alteplase (Activase) Thrombolytic agents

Precautions:

Not to be used if brain

injury or hemorrhage, un-

controlled HTN

Must be administered

within 3-6 hrs of onset of

stroke symptoms

Intracerebral hemor-

rhage is majorcomplica-

tion

Dissolve blood clots at site

of intravascular injury

Activate plasminogen to

plasmin

Plasmindigests clots

and coagulation factors

USES:

Acute MI, pulmonary em-

bolism, ischemic cardio-

vascular events

SE:-Dont use while pregnant

-Internal, superficial, intra

cranial bleeding

ASA (Aspirin)events platelet aggregation

inhibiting cyclooxygenase

platelets, preventing syn-

esis of TXA2 and prostacy-clin

ent of choice to prevent

romboembolic events

Clopidogrel (Plavix)hibits platelet aggregation

y inhibiting the binding of

ADP to platelet receptor

Antiplatelet agents

Precautions:

GI bleeding with

clopidogrel [plavix],

NSAIDs, warfarin, steroids

Need to discontinue

prior to procedures

Block formation of blood

clots by preventing

platelet clumping

USES:

Prevention of stroke, MI,

CV death

SE:

Dose-related and duration-relatedGastrointestinal

disturbances [nausea, dys-

pepsia, heartburn]

Bleeding


18/21

Used if allergy to ASA or in-

erance to ASA or in combi-

ation with ASA for certain

CV indications

Prasugrel (Effient)DP receptor antagonist just

e Plavix Advantages?: Less

netic polymorphism issues

than Plavix

Protamine sulfate Reverses heparin OD

Start EX 3

Diabetes mellitus

Drug Name Class Works on S/S notes

Glyburide(Micronase)

Sulfonureas

Pancreas

Hypoglycemia,

weight gain, GI,

photosensitivity,

Take 30 min prior to

meal

Glipizide(Glucotrol)

Sulfonureas pancreas Hypoglycemia,

weight gain, GI,

photosensitivity,

Take 30 min prior to

meal

Metformin(Glucophage)

Metformin

Liver, skeletal mus-

cles- NO INSULIN SE-

CRETION

GI (titrate up),

taste, Lactic acido-

sis

Contraindications: se

rum creatinine:

greater than 1.4 f or

1.5 m, liver disease,alcoholic, hx of LA,

HF, stop prior to pro-

cedure with contrast


19/21

Rosiglitazone (Avandia)

Pioglitazone (Actos)

thiazolidinedi-

ones

Liver, skeletal mus-

cles, adipose tissue

insulinsensitizers

Hepatic fail-

ure/death (Avan-

dia), GI, BMS,

weight gain (less

than SFUs), edema,

CHF

Recent press: Avandi

is increased CV risk-

similar effects of con

trol versus rosi group

Repaglinide Meglitinides

Pancreas- Similar to

sulfonylureas but

shorter acting

Hypoglycemia,

H/a, upper resp in-

fections

Acarbose

(precose)

Alpha-gluco-

sidase inhibi-

tor

Delays breakdown of

ingested carbs, reduc-

ing post prandial hy-

perglycemia

GI- lifechanging

FLATULENCE,

hepatotoxicity-

baseline LFTs

Take with first bite of

meal, do not eat=do

not take med

Repaglinide (Prandin) Meglitinides Similar to sulfonylu-

reas but shorter act-

ing

Increase insulin re-

lease from pancreas

Hypoglycemia

[less so than SFUs]

Headache

Upper respira-

tory infections

For pts that the SFU

hypoglycemia was

too pronounced.

Still possibility of

weight gain less pro-

nounced

Exenatide [Byetta] GLP-1 ana-

logue

(new agent for

type ii)

Binds to GLP-1 recep-

tors which increases

glucose dependent

insulin secretion; in-

hibits appetite and

stimulates release of

insulin when glucose

levels become too

high

Minimal Hypogly-

cemia, Nausea, mi-

nor weigh loss

Administered SC BID

prior to meal

BLACK BOX-

PANCRETITIS

-no real proof

Sitagliptin

(Januvia)

DPP-IV Inhibi-

tors, the

Gliptins

Competitive-reversi-

ble inhibitor of DPP-

IV (increases GLP-1)

Increase glucose de-

pendent insulin secre-

tion

Moderate glucagon

secretion

Hypoglycemia

[minimal]

Nausea Diarrhea

risk of infec-

tion?

Caution in renal

insufficiency

Increases chance of

weight loss

Pancreatitis or thy-

roid cancer


20/21

Delay gastric empty-

ing

Reduce food intake

New black box

warning [pancrea-

titis]

Octreotide

(Sandostatin)

Pituitary

Drugs

Somatostatin

Impairs gallbladder

function

Effects glucose regu-

lation in HYPOglyce-

mic type I and may

cause HYPERglycemia

in ot w type ii or w/o

diabeties

Enhances effects of

prolong QTc inter-

val

Caution in renal im-

pairment

Adrenal diseaseDrug Name Classification How it works SE Precautions

smopression

DAVP]

Pituitary drugs Artificial ADH hormone

used to suppress affect-

ing the posterior pitui-

tary. Reducing water

excretion

Also used for nocturnal

enuresis

Drowsiness, diz-

ziness, headache

GI [stimulation

of GI motility]

Local nasal irrita-

tion

Major complica-

tion

hyponatremia

Occurs if exces-

sive fluid intake

Check serum so-

dium regularly

ednisone

eltasone)

nger duration

eferred

ed in combo to

at Addisonsdis-

se

ethylpredniso-ne[Medrol]

Glucocorticoids Block inflammatory

mediators and anti-

body formation in im-

mune system

Can be used to treat

chronic asthma & bron-

chitis

Associated with

systemic admin-

istration

Fluid retention,

weight gain, in-

somnia, glucose in-

tolerance, mood

changes, growth

retardation

In presence of in-

fection

Diabetes

--bc it effect glu-

cose tolerance

drocortisone

orinef]

Mineralocorti-

coids

Stimulate retention of

sodium and water and

excretion of potassium

Uses: treating ad-

renal insufficiency; or-

thostatic hypotension

Side effects:

Fluid retention,

edema, HTN,

hypokalemia

Cautions: severe

HTN, heart failure


21/21

Thyroid disease

Drug Name Classification How it Works/

Uses

SE Cautions

Methimazole

[Tapazole]

-once daily admin-

istration

Antithyroid drugs

Hyperthyroidism

Block production

of thyroid hor-

mones by inhibit-

ing enzyme thyrop-eroxidase

Lethargy, brady-

cardia]

Bone marrow sup-

pression

Propylthiouracil

[PTU]

-q8h administra-

tion

Antithyroid

Hyperthyroidism

Block production

of thyroid hor-

mones by inhibit-

ing enzyme thyrop-

eroxidase

Also inhibit con-

version of T4 to T3

Lethargy, brady-

cardia]

GI [more so with PT

Levothyroxine

[Synthroid]

T4 salt; preferred

due to predictable

bioavailability

Thyroid Replace-

ment Drugs

Hypothyroidism

Replace thyroid

hormones not be-

ing produced

Nervousness,

tremors

Insomnia

Arrhythmias, HTN

Nausea, vomiting

Diaphoresis

Weight loss

Indicate drug has

been titrated too

much

Has MANY drug inter-

actions

-take on an empty

stomach

-separate from other

meds like iron, antac-

ids, and vitamins.

-Take in the morning,

separated from every

thing else.-Take every day and

do not skip doses.

Atenolol Beta Blocker Used to prevent

heart attacks and

treat HTN and an-

gina

Nonselective beta

blockers blunt sys of

hypoglysemia

Avoid sudden with-

draw

May delay recovery

from hypoglycemia fo

pts w Type I

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