pharm-drugs charts
TRANSCRIPT
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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 ^
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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
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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)
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Drug Action Category Name Notes
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
Drug Action Category Name Notes
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
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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
Drug Action Category Name Notes
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
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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
Drug Action Category Name Notes
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,
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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
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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
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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
or retards formulation of
new thrombi
No test for monitoring,
only given sub-q, pre-
measured doses
Hematuria, GI bleeding,
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
or retards formulation of
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!
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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
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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
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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
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(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
automaticity at SA node
conduction velocity at AV
node contractility
Uses: to slow ventr rate in
Afib or terminate SVTs
SE: BP, HR, constipa-
tion, AV block
Adenosine Other How it works:
automaticity at SA node
conduction velocity at AV
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)
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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.
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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!
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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
Hematuria, GI bleeding,
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
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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
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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
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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
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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
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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