Drug Name

Category

s/s

Pt teaching

Albuterol- rescue
Salmeterol- long term

2 agonists
Bronchodilators

Increased HR, tremors,

insomnia, tolerance,
hypokalemia

How/when to appropriately take. Albuterol is

rescue only

Ipratropium (Atrovent)shorter
Tiotropium (Sprivia)long acting

Anti-cholinergics
Bronchodilators
Block PSS- antagonist of
acetylcholine

Dry mouth, constipation(rare if inhaled)

Theophylline

Xanthines
Bronchodilators
Inhibit phosphodieserase enzyme

Irritability, restless ness,

GI, Cardiac stimulation
(increased HR, arrhythmias) CNS stimulation
(excitability, insomnia,
seizures)

Fluticasone(Flovent)
Corticosteriods
long term inhaled
Anti-inflammatory
Budesonide (Pulmicort)long term inhaled
Montelukast (singular)

Leukotriene Modifiers
Anti-inflammatory
Selectively antagonize
receptor for production
of leukotrienes- allergies

Pseudoephedrine (Sudafed)
Phenylephrine

Oral decongestants
Decreases blood flow to
capillaries causing
shrinking of nasal passages

Oropharyngeal candidia- Advise pt to rinse mouth

sis,
after use
Sore throat

Cardiac stimulation,
restlessness, insomnia,
tremors

Diphenhydramine (Ben- Anti-histamines

adryl)- 1st gen
H1 blockers
Loratadine (Claritin,
Alavert)- 2nd gen

Sedation, drying
Less so with 2nd gen

Dextromethorphan
(Delsym, Robitussin
DM)

Anti-tussive
Centrally acting through
medulla to suppress
cough

Sedation, dry mouth

Guafenesin (Robitussin,
Mucinex)

Expectorants
Thin secretions

GI

Respiratory Drugs ^

Serum drug monitoring,

smokers metabolize
faster, COPD maintenance, narrow therapeutic window
BAD DRUG

Precautions in pregnancy, HTN, cardiac pts.

(Controlled substance
due to meth production)

ANS Drugs
Alpha/Beta drugs
Drug Name

Category

S/S

Uses

Epinephrine

Alpha1/2 and beta 1/2 adrenergic agonist

BP/HR/contractility/bronchodilation
At higher doses- increases HR/O2 consumption
MAP

Ventricular arrhythmias, HTN,

angina, hyperglycemia(use insulin
drip)

anaphylaxis

Norephinephrine
(No rep: No respiration: 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 lubdub-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

For pts who cannot

tolerate Beta effects
or when pure vasoconstriction required
Used post op w/ pts
w/ low SVR

(also an oral decongestant)

Cholinergic Agents
Drug

Category

s/s and cautions

uses

Bethanechol

Direct cholinergic agonist

Increases bladder tone
and urinary excretion

N/V cramps, diarrhea,

salivation, bradycardia,
hypotension, flushing,
diaphoresis
Use sparingly due to systemic PS effects and in
pts. with respiratory disease or bradycardia

Treats/prevents UTI
GERD in infants

Neostigmine/
physostigmine

Indirect cholinergic agonist

Myasthenia Gravischronic muscular disease results in destruction of Ach receptors

Donepezil
(I want Alzheimers disease to be DONE with!)

Indirect cholinergic agonist

Alzheimers Disease- progressive loss of Ach producing neurons

Atropine

ANTI-cholinergic
Relaxes GI tract, inhibits
GI secretions

Bradycardia, dilate pupils, prior to surgery

Antibiotics
Drug Action

Category

Name

Notes

Blocks cell wall

synthesis

Beta-Lactams
Penicillins

Penicillin (syphilis/dental)
Amoxicillin
Amoxicillin-Clavulante (Augmentin)(beta-lactamase inhibitor)
Nafcillin (MSSA/skin infections)

Not active against MRSA

GI side effects/rash
PCN combinations like Augmentin for betalactamase
inhibitor

Methicillin-sensitive Staphylococcus aureus

Blocks cell wall

synthesis

Beta-Lactams
Cephalosporins

Cefazolin (1st gen)

Cephalexin (1st gen) (Glenn)
Cefoxitin (2nd gen)
Ceftriaxone (3rd gen): cleared by liver
(not kidney like the rest of them)

Cefepime (4th gen)

(As you go up the generations (1, 2, 3, 4)
your gram negative coverage increases)

1st gen- 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 kidneysyou need to adjust the dose or
they may get seizures)

Blocks cell wall

synthesis

Beta-Lactams
Carbapenems

Imipenem
Meropenem

Broadest spectrum, often

used 1st and for mixed infections, can lower seizure
threshold

Blocks cell wall

synthesis

Glycopeptide

Vancomycin

Gram + only
MRSA
No cross between PO and IV
Nephro/ototoxicity
Red mans syndrome (they
feel allergy but arent: prob b/c
of rate of infusion)

Dosed via pharmakinetics

PO: CANT be used to treat systemic infections (MRSA)

Drug Action

Category

Name

Notes

Protein Synthesis
inhibitors

Aminoglycosides

Gentamicin
Tobramycin

Nephro/ototoxicity esp. with vancomycin

Gram bacteria (Pseudomonas)
Dont mix 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 infections (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 transcription in mRNA

and protein

TB drugs

Rifampin

Red discoloration of bodily fluids, hepatotoxic, GI side effects

Inducer of CYP450

Isoianzid (INH)

Hepatotoxic, peripheral neuropathy (prevented with vitamin B6)

Inhibit DNA synthesis by inhibiting DNA gyraseCIDAL

Fluroquinolones
(FQs) (most over-

Ciprofloxacin (older:

Pneumonia, UTI, great bone penetration,

travelers diarrhea (cipro) Mixed infecused antibiotic in US)
tions (mox)
Levofloxacin &
S/s GI, hyperglycemia, Achilles tendon
Moxifloxacin (Newer:
rupture, Prolonged QT
enhanced gram-(+) activity
Caution
with kids (CF pts. use)
& anaerobes)
CYP450 inhibitor
better gram-(-) coverage,
weak gram (-) activity)

Elderly do not tolerate well

Block incorporation of PABA

Sulfas

TMP-SMX
sulfadiazine

Gram +/Inflammatory bowel disease, UTI, acute

otitis media, some MRSA
S/S rash/GI
Photosensitivity, increase fluid intake

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

Ganciclovir (Cytovene)

PO availability low; also given IV

Biggest issue: bone marrow suppression

Anti-Viral Agents

Inhibit DNA synthesis by inhibiting DNA gyraseCIDAL

Agents for CMV

(cytomegalovirus)

Inhibits activity of
enzyme

Anti-flu

Tamiflu

Inhibits enzyme
that synthesizes
HIV DNA (thus
preventing viral
DNA from forming)

Anti-retroviral

Zidovudine

Used for treatment of HIV/AIDS infection

-1st U.S. govt approved treatment for HIV

Category

Name

Notes

Anti-Fungal Agents
Drug Action
Forms tube in cell
membrane that
drains ions

Amphotericin B

Interferes with
fungal synthesis

Ketoconazole

Used IV for systemic fungal infections

(Amphotericin A doesnt do shit for fungal infections)

Used PO to treat fungal infections (i.e.

tinea) and dandruff
Ketoconazole has been used as a treatment for androgen-dependent prostate
cancer

Exam 2
Cardiovascular Drugs
Drug Name

Atenolol (Tenormin)
Metoprolol (Lopressor,
Toprol XL)
Propranolol (Inderal)

Class/precautions
Beta blockers
-selective
-selective
-nonselective

How does it work?

Block effects of SNS by
binding to beta receptor

Uses and S/S

Uses: HTN, angina, arrhythmias, AMI core

measure, CHF, Migraine
B1- lowers HR, contractil- prophylaxis, performance
ity, lowers renin release
anxiety
B2- bronchoconstriction
**selective for respiratory
diseases
S/S low HR/BP, dysrhythmias (affecting conduction); AV block, impotence
Precautions: may mask
symptoms of hypoglycemia, must taper,

Spironolactone [Aldactone]
nonselective synthetic
steroid; also binds some
androgen receptors
Eplerenone [Inspra]
selective

Enalapril (Vasotec)
IV
Ramipril (Altace)
HF
Captopril (Capoten)
Not a prodrug
Shortest half life

Losartan (Cozaar)
HF

Aldosterone
Antagonists
Potassium Sparing Diuretic

Block receptors for

aldosterone

Uses: HTN, HF
S/S: Hyperkalemia [careful with salt substitutes]
Gynecomastia, hirsutism [spironolactone]

ACE inhibitors
-precautions with bilateral renal artery stenosis,
pregnancy
-less effective with African Americans
-monitor BP, SCr, K+
-ACE escape

-Suppress RAAS
- blocks conversion of Angiotensin 1 to 2 (2 is a
vasoconstrictor)
-blocks degradation of
bradykinin (dilator)->
causes angioedema

Uses:
-reduces systemic vascular resistance- HTN
-prevents renal failure in
diabetics( diabetic neuropathy)
-prevents vascular remodeling (MI, AMI core
measure)
-prevents progression of
heart failure (CHF, core
measure)
S/S--dizziness, orthostatic hypertension, GI distress, nonproductive
cough, headache, hyperkalemia (potassium inversely related to aldosterone)
-all excreted by kidney
-prodrugs: convert to active form in liver
-reduced absorption with
food except enalapril

ARBS
startans

Blocks the effects of angiotensin 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

Alpha 2- agonist

Act within the brainstem

to suppress sympathetic
outflow to the heart and
blood vessels: vasodilation,

Uses: HTN (methyldopa),

chronic pain, menopausal
symptoms, withdrawal
from opioids
S/S dry mouth, sedation,
low BP, rebound HTN,
slow taper Positive
Coombs test and hemolytic anemia

someone who gets this is

started on an ACE or
some other drugs and is
looking to get more of a
hormonal blockade

Valsartan (Diovan)
Clonidine (Catapres)
lowers CO
Methyldopa (Aldomet)
(HTN in Pregnancy)
HTN/vasodilates
Hepatic injury

Terazosin (Hytrin)
Tamsulosin (Flomax)
(wont affect BP, not systemic)

Nifedipine (Procardia)
(gingival hyperplasia)
Amlodipine (Norvasc)

Alpha 1 blockers
Adrenergic Drugs

Prevents stimulation of
a1 receptors on vessels,
resulting in vasodilation.
1. Dilate arteries, veins
2. Relaxes smooth muscle
in bladder neck and prostate.

Uses: HTN with BPH, not

for HTN alone.
S/S: orthostatic hypotension, dizziness/drowsiness, vivid dreams
Warn of 1st dose orthostasis; admin at bedtime, slow titration of
doses.
Do not take with Viagra
(increased risk of hypotension)

CC Blockers
(Calcium antagonists)
Dihydropyridines- primarily vasodilates
-P450 and Grapefruit
juice
-Betas
-Dig

Prevents Ca++ from entering cell at

1. vascular smooth muscle-> vasodilation

Uses: HTN, Angina,

S/S: reflex tachycardia
Flushing, edema, heachache, dizziness, hypotension, gingival hyperplasia
(nifedipine)

CC Blockers
(Calcium antagonists)
non-Dihydropyridineseffect on cardiac conduction
-P450 and Grapefruit
juice
-Betas
-Dig
Not for use in CHF

Prevents Ca++ from entering cell at

1. vascular smooth muscle-> vasodilation
2. heart -> lowers HR (SA
node) and conduction
(AV node)

Uses: HTN, Angina, Arrythmias

S/S:
Lowers HR, AV block,
Constipation
Flushing, edema, heachache, dizziness, hypotension

Vasodilator
Diuretic 394

BP via vasodilation
when administered IV infusion.

Not for use in CHF

Verapamil (Calan, Verela)
(Constipation)
Diltiazem (Cardizem)

Sodium Nitroprusside
(Nitropress)

Narrow therapeutic index

Nitroglycerin (Nitro-Bid,
Nitrostat) (rapid)
Isosorbide mononitrate
(Imdur)
Nitrodur patches
(long)

Nitrates pg 369-371
Precautions:
Drug allergy
Severe anemia
Closed angle glaucoma
Hypotension and
Severe head injury
Deaths reported w drug
interactions of meds for
erectile dysfunction

OD- Treat w IV Ca

OD- Treat w IV Ca

Relax vascular smooth

muscle via stimulation of
intracellular GMP
1. reduce myocardial demand by decreasing preload
Effects: Major dilation of
venous bed
1. work on heart
2. does NOT affect cardiac
function

Uses: HTN emergencies

(diastolic >120)
S/S: flushing, profound
hypotension, H/A, dizziness, reflex tachycardia
Cyanide poisoning with
prolonged use(>72hrs)
-CNS effects, delirium
-monitor levels of theocyanate
Uses: rapid acting- first
line for acute attacks, to
treat stable, unstable vasospastic angina
Long acting- maintenance
or prevention of angina
SS: Headache tachycardia(REFLEX TACHYCARDIA) postural hypotension
Topical- contact derititis

Digoxin-BAD DRUG

Cardiac Glycosides
Mechanical and electrical
effects on the heart

Inhibits sodium potassium pump resulting in

increased calcium accumulation

Uses: Arrhythmias, CHF

S/S GI symptoms (first
sign), arrhythmias, headache, yellow halo,
blurred vision
Predisposing factors to
cardiac toxicity: hypokalemia (diuretics),
Heart disease, elevated
digoxin levels
Target level 0.7-1.2
Do EKG for toxicity pts
Antidote- digibind

Phosphodieesterase inhibitor acts as a cardiotonic or inotropic agent

Uses: short term for pts

who have decompensated
these pts are waiting for
heart transplants etc
on these drugs bc we
have nothing left

Positive inotrope- improve force of contraction

Negative chronotropedecreases conductivity

Milrinone (Primacor)

No class

Blocking phosphodiesterase enzyme

calcium in cells, leading
to stronger contraction
in cardiac muscle

S/S ventricular arrhythmias, hypotension, GI

Really only use in last
stage of HF

Anticoagulants
Name

Class

Precautions/monitor

S/S

Heparin
Intrinsic overdose treating with protamine sulfate

Anticoagulant- prevents
or retards formulation of
new thrombi

PTT/CBC with plateletsHematuria, GI bleeding,

only IV (link between
hemoptysis, thrombocylong term therapy and os- topenia (loewplatlets)
teoporosis

Enoxaparin (Lovenox)LMWH

Anticoagulant- prevents
or retards formulation of
new thrombi

No test for monitoring,

only given sub-q, premeasured doses

Hematuria, GI bleeding,
hemoptysis, thrombocytopenia less likely than
heparin

Warfarin (coumidin)
-vitamin K antidote
promotes synthesis of
factors only for INR over
5, can develop resistance
if vitamin K is still in system

Anticoagulant- prevents
or retards formulation of
new thrombi
-Does not provide instant
protection 2-3 days of
heparin needed in addition if treating DVT
-blocks vitamin K binding
sites and inhibits synthesis of vitamin K dependent factors and proteins
CNS
Teratogenic- cross BBB

INR
-maintain fixed intake of
vitamin K
-extensive interaction
with P450 system

Minor bruising or bleeding, nasal mucosal, major

GI bleeding, hematuria,
teratogenic!

Streptokinase

Thrombolytic: DISSOLVE
blood clot at site of injury
by activating plasminogen to plasmin which digests the clot and coagulation factors.

Not to be used if brain injury or hemorrhage, or

with uncontrolled HTN.
Must be given 3-6 hrs of
symptoms. Intracerebral
hemorrhage is a MAJOR
complicatin.

Uses: Acute MI, PE, ischemic cardiovascular

events.
Door to needle time
30mins

Aspirin

Antiplatelets- prevents
platelet aggregation by
inhibiting cyclooxygenase
in platelets

Uses: prevent stroke, MI,

CV death
S/S dose/duration related, GI disturbances,
bleeding, discontinue
prior to procedures

Plavix

Antiplatelets- prevents
platelet 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 related, 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 sensitive lipase that leads to
inhibition of free fatty
acids from adipose tissue

Primary effect HDLs

and TG
Primary focus is to increase HDL

S/S facial flushing

(blunted with ASA administration, slow dose titration, tolerance over time),
GI
Precautions: liver toxicity, impairs glucose tolerance, increases uric
acid levels, increased risk
of rhabdomylysis when
used with statins

Ezetimibe (Zetia)
(Prince)

Selective Cholesterol
Absorption Inhibitors
Selectively inhibits absorptions of cholesterol
from dietary and biliary
sources

LDL/TG
HDL used as monotherapy 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

Colestipol (Colestid)

Bile Acid Sequestrants

Anion-exchange resins
bind to bile acids in intestinal lumen, form insoluble complexes, allow for
increased secretion of
bile acids, not systemically absorbed

LEAST EFFECTIVE

Fenofibrate (Tricor)

Fibric Acid Derivatives

Precise mechanism unknown

TG concentrations
HDL
minimal effect on LDL

S/S dyspepsia, Hepatotoxicity

Monitor LFTs
Increases risk rhabdomyolysis when used with
statin

LDL/TG
HDL
primary focus is LDL

NO GRAPEFRUIT JUICE!
S/S GI headache, photosensitivity
Monitor LFTs, serum Cr,
CPK
Precautions: myopathy,
and rhabdo, restricted to
80mg due to risk
Hepatoxicity
Contraindicated in active
liver disease
Take in the evening

Effects: Major dilation of

venous bed
Decrease work on heart
Does not affect cardiac
function (HR or contractibility)

S/S Postural hypotension,

headache, dizziness, reflex tachycardia, cutaneous vasodilation with
flushing

Gemfibrozil (Lopid)

Uses: more cholesterol

circulating for conversion
More cholesterol circu- to bile acids, increased calating for conversion to tabolism of LDL by liver
S/S bloating, constipabile acids
tion, nausea precautions:
Increased catabolism
interferes with other
of LDL by live
drugs- by binding with
them
administer 1 hr before
or 3-4 hrs after

lower triglycerides and

boost HDL
for the families that
have hypertriglyceridemia
Atorvastatin [Lipitor]
(most effective)
Simvastatin [Zocor]
Pravastatin [Pravachol]
(not metabolized by
CYP450, used by pts
with transplants/HIV)

Isosorbide mononitrate
[Imdur]
longest acting PO
agent, once daily

HMG-CoA Reductase Inhibitors (statins)

Inhibit enzymes necessary for precursor of cholesterol ONLY DRUGS
THAT DIRECTLY WORK
ON THE CHOLESTERAL
PATHWAY

-block that enzyme that

prevents the conversion
to Mevalonate- cutting
out the cholesterol pathway
Nitrates (NTG)
Relax vascular smooth
muscle via stimulation of
intracellular GMP

Transdermal [NitroDur] Reduce myocardial demand by decreasing preload

LONG ACTING
Maintenance or prevention of future anginal attacks

Precautions:
Tolerance (need nitratefree period) -NITRODUR
Withdrawal when abrupt discontinuation
Rebound HTN and angina
Do not carry close to
body; keep in cool place
Drug interactions (other
dilators)

Dysrhythmic Agents
Name

Class & Precautions

How Does it work

S/E and Uses

Class Ia

Quinidine
Procainamide
SLE syndrome

Proteinbound
Drug interaction with digoxin
[displaces digoxin from albumin]

Work Block Na+ channels in

cell membrane during action
potential
- Affect Phase 0 during the
Action Potential-Blocks the
Na channels
Strongly anticholinergic
(blocks inhibit parasympatic
NS);
ventr rate [pretreat with BB
or CCB]

Lidocaine

Class Ib Agent

Flecainide [Tambocor]

Class Ic

Propafenone
PO Agent
Used for ventricular arrhythmias or paroxysmal
atrial tachycardia

Generally not used in current

clinical practice due to CAST
data and better agents

Widens QRS and prolongs

QT
Work Block Na+ channels in
cell membrane during action
potential
Affect Phase 0 during the
Action Potential- Blocks the
Na channels

Uses: Afib, premature atrial

contractions, premature ventricular contractions, ventricular tachycardia and WolfParkinson-White Syndrome
S/E: Hypotension,
QRS > 50% prolongation,
GI symptoms, Cinchonism
blurred vision, tinnitus
Albumin bound- not good w
dig
Prototype SE
Not seen a lot due to bone
marrow suppression
Uses: Ventricular dysrhythmias only(premature ventricular contractions, ventricular
tachycardia, Vfib)
Short term IV for ventricular arrhythmia

Differs from Ia [accelerates

repolarization]

SE Metallic taste, slurred

speech, Convulsions CNS
effects (Agitation, Anxiety,
Seizures)
Little or no effect on EKG

Work Block Na+ channels in

cell membrane during action
potential
- Affect Phase 0 during the
Action Potential- Blocks the
Na channels

Uses: Severe ventricular

tachycardia and supraventricular tachycardia
dysrhythmias, Afib and flutter and Wolf-ParkinsonWhite Syndrome
ventricular arrhythmias or
paroxysmal atrial tachycardia

BAD DRUGS
SE: risk of death

Propranolol [Inderal]
Non-selective
PO Treatment of HTN, angina, migraine prophylaxis
(MOST COMMON)

Beta Blocker
Class II

automaticity at SA node

Cautions:
Pre-existing bradycardia
CHF, asthma, COPD

contractility

Esmolol [Brevibloc]

conduction velocity at AV
node

Affects Phase 4 of the Action

Potential-decreases spontaneous depolarization

Selective
IV agent with short t1/2 Immediate control of SVTs and
tachycardia

Uses: Treatment of SVTs

and PVCs [supraventricular
tachycardias; premature ventricular contractions]
SE CNS [dizziness, drowsiness]
CV [ BP, HR]

Acebutolol [Sectral]
Selective
PO agent; Treatment of HTN
and PVCs

Amiodarone
PO, IV for atrial/ventr arrhythmias Drug of choice

Class III

Block K+ channels; prolong

phase 3; prolong repolarization

Uses: Life Threatening

Ventricular tachycardia of fibrillation

(afib emg) for ACLS treatment of ventricular arrhythmia

Cautions: When used in

presence of hypotension or
shock Prolong QT interval

Dofetilide [Tikosyn]

CYP450 3A4 interactions

with amiodarone; t1/2
amiodarone 25 -110 days

PO Conversion of Afib to
NSR; maintenance of NSR Cr
Cl calculation important-need
to be supervised while treated

SE:
-Prolonged OT interval
-Hypotension, CHF GI
Pulmonary toxicity, skin
discoloration (BLUE), thyroid [amiodarone]

Ibutilide [Corvert]
IV Rapid conversion of Afib
of recent onset < 90 daysneed to be supervised while
treated

Bretylium IM,
IV Short-term treatment of
ventricular arrhythmias when
others fail

Diltiazem
Verapamil

Adenosine

Class IV
Ca Channel Blockers

How they work: Block Ca++

channels in cell membrane

Non-Dihydropyridines

automaticity at SA node

Cautions: digoxin, BB

conduction velocity at AV

Other

node contractility
How it works:
automaticity at SA node
conduction velocity at AV
node

Uses: to slow ventr rate in

Afib or terminate SVTs
SE: BP, HR, constipation, AV block
Uses: Treatment of paroxysmal SVTs or WPW syndrome
T1/2 1.5 to 10 secs.administered IV bolus as close
to the heart as possible
SE flushing, dyspnea, hypotension

Diuretics
Name

Class

How does it work?

S/S and uses

Hydrochlorothiazide
(HCTZ) (HydroDiuri)

Thiazide Diuretics
(belong to chemical class
sulfonamides)

Block chloride pump in

early distal convoluted
tubule.
Na, Cl, K and minor loss
in water.
levels of uric acid and
glucose

Uses: Mild diuretics. Uncomplicated HTN.

Chlorthalidone
(Hygroton)

Precautions:
Dont use if pregnant.
risk of digoxin toxicity
(b/c of K levels).
DM and gout
Caution in pt w/ DM,
gout or sulfa allergy.

*Small dosage range

S/S:
Hypotension & dehydration
-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)

Acetazolamide (Diamox)

Carbonic anhydrase inhibitors

Work to block formation

of carbonic acid and bicarbonate in renal tubule

Cautions:
Patients with sulfa allerg

Inhibit enzyme, carbonic anhydrase, results

in decreased secretion of
aqueous humor of eye
Also slow down movement of hydrogen so
more sodium and bicarbonate are lost in urine

Furosemide
(Lasix)
Bumetanide

(Bumex)

Loop Diuretics

Uses: Mild diuretics used

most often to treat glaucoma
Not used clinically to treat
HTN or edema
S/S
metabolic acidosis [loss of
bicarb];
hypokalemia

Precautions
-Take in the morning

Work in loop of Henle.

Large loss of water, Na
and K. Most potent diuretic.

Uses: Acute PE, CHF and

edema.
Esp useful in pts w/ renal
failure.

-Monitor bp,

*very large dosage range

-Caution for postural

hypotension.

Most potent diuretic used

in ACUTE SETTINGS

S/S:
Hypotension
-dizziness, lightheadeness
Dehydration
-dry mouth, scanty urine
output
Hypokalemia,
Ototoxicity (increase risk
if pt on aminoglycoside(antibiotics))
Hyperglycemia is not common.

-Consume K rich foods.

Triamterene (Dyrenium)
Potassium-sparing Diu( Acts more quickly.
retics
Non aldosterone antagonist (Aldosterone Inhibiting)
Direct decrease in ion
transport,
Uses:HTN, edema)
Spironolactone
(Aldactone)
(More chronic use-slower
onset- 48hrs.
Aldosterone antagonist
Affects ions by blocking action of aldosterone in distal
nephron
Uses: HTN, Heart failure,
edema, primary hyperaldosteronism)
Mannitol (Osmitrol)

Act to spare K in exchange for loss of Na and

water in urine.
Used in combination
with thiazides or loops
Rarely used alone b/c
limited diuresis
Corrects K+ loss of
other diuretics
FYI: never combine w/K
supplements, ACEi, or
other K sparring diuretics.

Uses: HTN, edema, (Spironolactone is also used for HF

and primary hyperaldosteronism.)
-Preferred if K loss is dangerous (digoxin or arrhythmias).
Rarely used alone b/c limited dieresis. Used with thiazides or loops b/c it corrects
their loss of K.
S/S: Hyperkamemia,
gynecomastia, hirsutism
(spironolactone),
blue urine(Triamterene)

Osmotic Diuretics
Precautions:
Hypersensitivity
Anuria
Severe dyhydration
Pulmonary congestion
Cerebral hemmhage
May crystalize when exposed to low temps
-should always be administered IV through a filter
-vials stored in warmer
pharmacy
-B4 administration vial
should be inspected for
precipitants

Use hypertonic pull to remove fluid from intravascular spaces and deliver
large amounts of fluid
into renal tubule.
Drug is highly controlled
usually in ICU settings.

Uses:
(IV) Decrease ICP, prevent
renal failure, decrease intraocular pressure, and promote movement of toxic substance through kidney. Drug
intoxication (to induce diuresis)
S/S: sudden drop in fluid levels, hypotension, electrolyte
imbalances.

Anemias
Drug name

Class & how it works

What it is used for

S/S and precautions

Darbepoetin (Aranesp)
*Long acting

Recombinant hormone:
Stimulate production of
RBCs in bone marrow.
Goal of drug is to get Hgb
12g/dL.

Anemia associated with

CKD. Administered SC or
IV.

Pts should receive iron supplements. May take 6 weeks

to see effects. Used to reduce need for transfusion
only.
S/S: Hypertension, headache, edema, fatigue, HF, arrhythmias.
IN NEWS: if abused may
cause blood clots and spur
tumor growth!

Epoetin (Procrit, Epogen)

Is abused and used to

raise RBCs higher than
needed to prevent fatigue

Ferrous sulfate

Iron Salt: Iron enters

bloodstream and is transported to liver, spleen,
bone marrow where it becomes part of iron stores.

Treatment of iron deficiency in anemia

S/S: GI (constipation, black

feces)- titrate up to goal
dose to build up tolerance.
Take w/stool softener. Can
take with food but will bioavailability.
IV: Associated w severe Hypersentivity reactions
Interactions:
-antibiotics absorption
- acidic environment
absorption
-Vitamin C absorption

Cyanocobalamin (Nascobal) (Vitamin B)

Water soluble vitamin:

Available as nasal gel given
once weekly and 100mcg
IM/SC for 1 week then titrated to monthly.

Vitamin B12 deficiency.

Used when deficiency is
due to malabsorption.

Clinical improvement is increased alertness, appetite

and cooperation. Hct increases within 2 months.
Lifelong therapy.

CV III
Drug Name
Heparin
Unfractionated, Conventional
(large molecule)

Treatment of od/excess
with protamine sulfate

Class & Precautions

Anticoagulants
Precautions:
-Monitor aPTT [IV therapy]
-Monitor CBC with platelets (thrombocytopenia)
[IV therapy] Long-term
therapy and osteoporosis

How it works
Binds to antithrombin III

Uses and SE
USES:

and inactivates a number

of factors (see slide)
Inactivates intrinsic pathway
Inhibits conversion of
prothrombin to thrombin
and fibrinogen to fibrin

Stroke, MI, DVT, PE, LV

thrombus (AFib)
-Prevents or retards formation of new thrombi
-Prevents worsening of
thrombi damage
-allows almost instantaneous action

-SQ-Trying to prevent
clots
-IV- treating a clot
SE: Hematuria, GI bleeding, hemoptysis Thrombocytopenia
Low-molecular weight heparins (LMWH)

Enoxaparin (lovenox)
Smaller molecule

Anticoagulants
Monitoring:
Routine aPTT not necessary
CBC with platelets periodically

Warfarin [Coumadin]

Oral anticoagulants

Vitamin K is the antidote

When INR >5
Not for and acute situations

The only one in the US

Precautions

Products vary based on

size, anti-Xa activity, indications and dosage regimens
NOT considered therapeutically interchangeable
Enoxaparin (lovenox)
has been most widely used
-Check factor 10 A
Blocks vitamin K-binding
sites and inhibits synthesis of vitamin K-dependent factors (2, 7, 9, 10) and
proteins C and S

USES:
Surgery prophylaxis, DVTs,
PE

SE:
Same as UFH but >likely
Hematuria, GI bleeding,
hemoptysis
Hemorrhage, thrombocytopeni
USES:
Prevent extension of existing
thrombus and formation of
new thrombi

 Narrow therapeutic index

drug
Monitor INR (goal determined by indication for use)
and CBC with platelets
Maintain fixed intake of
Vitamin K [avoid binging on
green, leafy vegetables]
EXTENSIVE drug interactions with P450
Discontinuation prior to
procedure
-DO NOT USE WHILE PREGNANT

Vitamin K (pg)
Phytonadione

Vitamin

(Vitmain K1)

Dosage adjusted by INR

levels [general goal is 2-3]

-takes 72 hr for onset of action

Will NOT affect 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, hematuria, hemoptysis) Teratogenic!

Promotes synthesis of
clotting factors 2, 7, 9,
10

Aquamephyton

USES:
Reversal of bleeding due
to warfarin overdose
-PO dose depends upon
INR level (>5)

(Vitmain K1)

SE:
Difficult to overcome resistance after large doses
of Vit K administered
-making it hard to reinitiate warfarin therapy

Alteplase (Activase)

Thrombolytic agents
Precautions:
Not to be used if brain
injury or hemorrhage, uncontrolled HTN
Must be administered
within 3-6 hrs of onset of
stroke symptoms
Intracerebral hemorrhage is major complication

ASA (Aspirin)
Prevents platelet aggregation
by inhibiting cyclooxygenase
in platelets, preventing synthesis of TXA2 and prostacyclin
Agent of choice to prevent
thromboembolic events

Clopidogrel (Plavix)
Inhibits platelet aggregation
by 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

Dissolve blood clots at site

of intravascular injury
Activate plasminogen to
plasmin
Plasmin digests clots
and coagulation factors

USES:
Acute MI, pulmonary embolism, ischemic cardiovascular events

SE:
-Dont use while pregnant
-Internal, superficial, intra
cranial bleeding

Block formation of blood

clots by preventing
platelet clumping

USES:
Prevention of stroke, MI,
CV death

SE:
Dose-related and durationrelated Gastrointestinal
disturbances [nausea, dyspepsia, heartburn]
Bleeding

-Used if allergy to ASA or intolerance to ASA or in combination with ASA for certain
CV indications

Prasugrel (Effient)
ADP receptor antagonist just
like Plavix Advantages?: Less
genetic polymorphism issues
than Plavix

Protamine sulfate

Reverses heparin OD

Start EX 3

Diabetes mellitus
Drug Name

Class

Works on

S/S

notes

Glyburide

Sulfonureas

Pancreas

Hypoglycemia,
weight gain, GI,
photosensitivity,

Take 30 min prior to

meal

Sulfonureas

pancreas

Hypoglycemia,
weight gain, GI,
photosensitivity,

Take 30 min prior to

meal

Metformin

Liver, skeletal muscles- NO INSULIN SECRETION

GI (titrate up),
taste, Lactic acidosis

Contraindications: serum creatinine:

greater than 1.4 f or
1.5 m, liver disease,
alcoholic, hx of LA,
HF, stop prior to procedure with contrast

(Micronase)

Glipizide
(Glucotrol)

Metformin
(Glucophage)

Rosiglitazone (Avandia)
Pioglitazone (Actos)

thiazolidinedi- Liver, skeletal musones

cles, adipose tissue
insulin sensitizers

Hepatic failure/death (Avandia), GI, BMS,

weight gain (less
than SFUs), edema,
CHF

Repaglinide

Meglitinides

Pancreas- Similar to
sulfonylureas but
shorter acting

Hypoglycemia,
H/a, upper resp infections

Acarbose
(precose)

Alpha-glucosidase inhibitor

Delays breakdown of
ingested carbs, reducing post prandial hyperglycemia

GI- life changing

FLATULENCE,
hepatotoxicitybaseline LFTs

Take with first bite of

meal, do not eat=do
not take med

Repaglinide (Prandin)

Meglitinides

Similar to sulfonylureas but shorter acting

Increase insulin release from pancreas

Hypoglycemia
[less so than SFUs]
Headache
Upper respiratory infections

For pts that the SFU

hypoglycemia was
too pronounced.

Binds to GLP-1 recep- Minimal Hypoglytors which increases cemia, Nausea, miglucose dependent
nor weigh loss
(new agent for insulin secretion; intype ii)
hibits appetite and
stimulates release of
insulin when glucose
levels become too
high

Administered SC BID
prior to meal

DPP-IV Inhibitors, the

Gliptins

Increases chance of
weight loss

Exenatide [Byetta]

Sitagliptin
(Januvia)

GLP-1 analogue

Competitive-reversible inhibitor of DPPIV (increases GLP-1)

Increase glucose dependent insulin secretion
Moderate glucagon
secretion

Hypoglycemia
[minimal]
Nausea Diarrhea
risk of infection?
Caution in renal
insufficiency

Recent press: Avandia

is increased CV risksimilar effects of control versus rosi group

Still possibility of
weight gain less pronounced

BLACK BOXPANCRETITIS
-no real proof

Pancreatitis or thyroid cancer

 Delay gastric empty- New black box

ing
warning [pancrea Reduce food intake
titis]

Octreotide
(Sandostatin)

Pituitary
Drugs
Somatostatin

Impairs gallbladder
Enhances effects of Caution in renal imfunction
prolong QTc inter- pairment
Effects glucose regu- val
lation in HYPOglycemic type I and may
cause HYPERglycemia
in ot w type ii or w/o
diabeties

Adrenal disease
Drug Name
Desmopression
[DDAVP]

Classification
How it works
Pituitary drugs Artificial ADH hormone
used to suppress affecting the posterior pituitary. Reducing water
excretion

SE
Drowsiness, dizziness, headache
GI [stimulation
of GI motility]
Local nasal irritation

Precautions
Major complication
hyponatremia
Occurs if excessive fluid intake
Check serum sodium regularly

Also used for nocturnal

enuresis
Prednisone
(Deltasone)
-longer duration
-preferred
-used in combo to
treat Addisons disease
Methylprednisolone [Medrol]
Fludrocortisone
[Florinef]

Glucocorticoids

Block inflammatory
mediators and antibody formation in immune system

Associated with
systemic administration
Fluid retention,
weight gain, inCan be used to treat
somnia, glucose inchronic asthma & bron- tolerance, mood
chitis
changes, growth
retardation

In presence of infection
Diabetes
--bc it effect glucose tolerance

Mineralocorticoids

Stimulate retention of
sodium and water and
excretion of potassium
Uses: treating adrenal insufficiency; orthostatic hypotension

Cautions: severe
HTN, heart failure

Side effects:
Fluid retention,
edema, HTN,
hypokalemia

Thyroid disease
Drug Name

Classification

Methimazole
[Tapazole]
-once daily administration

Antithyroid drugs

Propylthiouracil
[PTU]
-q8h administration

Antithyroid

Hyperthyroidism

Hyperthyroidism

Levothyroxine
[Synthroid]
T4 salt; preferred
due to predictable
bioavailability

Thyroid Replacement Drugs

Atenolol

Beta Blocker

How it Works/
SE
Uses
Block production
Lethargy, bradyof thyroid horcardia]
mones by inhibiting enzyme thyroperoxidase
Block production
Lethargy, bradyof thyroid horcardia]
mones by inhibiting enzyme thyroperoxidase
Also inhibit conversion of T4 to T3
Replace thyroid
hormones not being produced

Hypothyroidism

Used to prevent
heart attacks and
treat HTN and angina

Nervousness,
tremors
Insomnia
Arrhythmias, HTN
Nausea, vomiting
Diaphoresis
Weight loss
Indicate drug has
been titrated too
much

Nonselective beta
blockers blunt sys of
hypoglysemia

Cautions
Bone marrow suppression

GI [more so with PTU

Has MANY drug interactions

-take on an empty
stomach
-separate from other
meds like iron, antacids, and vitamins.
-Take in the morning,
separated from everything else.
-Take every day and
do not skip doses.
Avoid sudden withdraw
May delay recovery
from hypoglycemia for
pts w Type I