REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Drug Mechanism of Action 3 Highly Testable Pearls

Hydrocodone/acetaminophen Hydrocodone - Binds, • Addiction/dependence
(Vicodin, Lortab, Norco) activates mu-opioid risk
receptor, Acetaminophen • Respiratory
– suspected to inhibit depression
prostaglandin synthesis • Constipation
which reduces pain
Lisinopril (Prinivil) Inhibits angiotensin • Cough
converting enzyme which • Hyperkalemia
ultimately leads to • Used to help protect
reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Simvastatin (Zocor) Inhibits HMG-CoA • Myopathy
reductase – this enzyme is • Reduces risk of heart
the rate limiting step in attack/stroke
cholesterol formation • Dosed at night
Levothyroxine (Synthroid) Synthetic form of thyroid • Binding interactions
hormone (T4) with calcium and iron
can lower
concentrations
• TSH is monitored to
adjust dose
• Signs of hypothyroid –
fatigue, dry skin,
constipation
Amoxicillin (Amoxil) Inhibits penicillin binding • Diarrhea
protein which prevents • Nausea/Vomiting
cell wall synthesis • Rash
Azithromycin (Zithromax) Binds 50s ribosomal • Longer half-life than
subunit and prevents many antibiotics
protein synthesis • GI adverse effects
• Rare risk for QTc
prolongation
Hydrochlorothiazide Blocks sodium • Frequent urination
(HCTZ);(Microzide) reabsorption in the distal • Elevate uric acid level
convoluted tubule of (exacerbate gout)
kidney • Can help with edema
and hypertension
Amlodipine (Norvasc) Blocks the entry of • Edema
calcium into smooth • No action on the heart
muscle, causing (compared to
vasodilation diltiazem, verapamil)

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• Used to help prevent

angina
Alprazolam (Xanax) Enhances GABA activity • Used for acute
which has sedative, management of
hypnotic, anticonvulsant, anxiety
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly
Metformin (Glucophage) Primarily decreases • Avoid in moderate to
hepatic glucose severe kidney disease,
production rare risk of lactic
acidosis
• GI side effects like
diarrhea is most
prominent
• First line agent in type
2 diabetes
Atorvastatin (Lipitor) Inhibits HMG-CoA • Myopathy
reductase – this enzyme is • Reduces risk of heart
the rate limiting step in attack/stroke
cholesterol formation • Higher intensity statin
Omeprazole (Prilosec) Inhibits H+/K+ ATPase • Short term only
pump in gastric parietal recommended for
cells (reduces hydrogen GERD
ion – stomach acid • Associated with low
concentration in stomach) magnesium and B12
• Most potent acid
blocking medication
class
Amoxicillin/Clavulanate Amoxicillin – see agent; • Diarrhea
(Augmentin) clavulanate – inhibits • Nausea/vomiting
beta-lactamase which is • Rash
produced by bacteria to
break down beta lactam
antibiotics
Atenolol (Tenormin) Blocks beta-1 receptors • Pulse monitoring
(found primarily in the • Can blunt beta-agonist
heart); prevents activity of activity (potentially
sympathetic nervous exacerbate asthma,
system leading to COPD)
reduction in heart rate • Can block signs of
and BP hypoglycemia
(exception sweating)

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Furosemide (Lasix) Blocks reabsorption of • Hypokalemia

sodium, chloride and • Frequent urination
water from the ascending • Can lead to
limb of the loop of Henle dehydration (rising
– increases urine output creatinine)
Metoprolol (Lopressor) Blocks beta-1 receptors • Pulse monitoring
(found primarily in the • Can blunt beta-agonist
heart); prevents activity of activity (potentially
sympathetic nervous exacerbate asthma,
system leading to COPD)
reduction in heart rate • Block signs of
and BP hypoglycemia
(exception sweating)
Sertraline (Zoloft) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Zolpidem (Ambien) Enhances GABA activity • Used for insomnia
which has sedative, only
hypnotic effects • Dizziness/sedation
• Generally avoid in
elderly
Oxycodone/APAP (Percocet) Oxycodone - Binds, • Addiction/dependence
activates mu-opioid risk
receptor, Acetaminophen • Respiratory
– suspected to inhibit depression
prostaglandin synthesis • Constipation
which reduces pain
Esomeprazole (Nexium) Inhibits H+/K+ ATPase • Short term only
pump in gastric parietal recommended for
cells (reduces hydrogen GERD
ion – stomach acid • Associated with low
concentration in stomach) magnesium and B12
• Most potent acid
blocking medication
class
Clopidogrel (Plavix) Blocks binding of ADP to • Prodrug – converted
the P2Y12 receptor; by to its active

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

doing this, it prevents metabolite by

platelet aggregation CYP2C19
• Bleed risk
• Often used in
combination with
aspirin following
stenting
Montelukast (Singulair) Blocks leukotriene • Used in asthma and
receptors in the lungs allergies
which reduces • Not a rescue
bronchoconstriction and medication
inflammation • Rare reports of
psychiatric adverse
events
Prednisone (Sterapred) Multiple possible • Suppression of HPA
pathways of reducing axis
inflammation and • Increases blood
suppressing the immune sugars, causes
system (inhibition of insomnia and GI upset
cytokines, chemokines, • Increases risk of
arachidonic acid etc.) osteoporosis
Escitalopram (Lexapro) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Ibuprofen (Advil) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Citalopram (Celexa) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • QTc prolongation risk
(higher doses, elderly
more susceptible)

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• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Albuterol (ProAir) Beta-2 adrenergic • Tremor
receptor agonist – relaxes • Tachycardia
bronchial smooth muscle • Usual drug of choice
and opens airways for acute relief of
respiratory symptoms
Fluoxetine (Prozac) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Gabapentin (Neurontin) Not well understood – • Dizziness
possible action on voltage • Sedation
sensitive calcium channels • Can accumulate in
renal disease
Warfarin (Coumadin) Inhibits vitamin K • Bleed risk
dependent production of • Routine INR
clotting factors 2, 7, 9, monitoring require
and 10 (most often goal is 2-3
with a few exceptions)
• Tons of drug
interactions
(metronidazole,
amiodarone, Bactrim
etc.)
Tramadol (Ultram) Binds, activates mu-opioid • Increases seizure risk
receptors leading to • Sedation
analgesic effects • Risk of dependence
and addiction
Clonazepam (Klonopin) Enhances GABA activity • Used for acute
which has sedative, management of
hypnotic, anticonvulsant, anxiety
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly

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Lorazepam (Ativan) Enhances GABA activity • Used for acute

which has sedative, management of
hypnotic, anticonvulsant, anxiety
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly
Cephalexin (Keflex) Inhibits penicillin binding • Diarrhea
protein which prevents • Nausea/Vomiting
bacterial cell wall • Primarily gram +
synthesis bacteria coverage
Cyclobenzaprine (Flexeril) Not well understood – • Sedating
skeletal muscle relaxant • Anticholinergic
possibly gamma and alpha potential (i.e. dry
motor system effects mouth, confusion,
etc.)
• Not well tolerated in
the elderly
Sulfamethoxazole/trimethoprim Sulfamethoxazole – • Significant interaction
(Bactrim, Septra) interferes with bacterial with warfarin
folate synthesis; • Beware of patients
trimethoprim blocks with a sulfa allergy –
production of should not take this
tetrahydrofolic acid in medication
bacteria by binding • Take with full glass of
dihydrofolate reductase water
Ciprofloxacin (Cipro) Inhibits DNA gyrase in • Risk of spontaneous
bacteria which prevents tendonitis or tendon
DNA separation and cell rupture
division • Dose adjustments
with poor kidney
function
• Binding interaction
with iron and calcium
can reduce absorption
Fluticasone (Flonase) Stimulates glucocorticoid • May work a little
receptors which leads to better if taken
reduced inflammation routinely
• Nose bleeding,
irritation
• Used in allergic rhinitis
Triamterene/HCTZ (Dyazide) Triamterene – blocks • Elevated K+ possible
epithelial sodium with triamterene
channels, causing a • Lowers blood pressure
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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

diuretic type effect in the • In combo with HCTZ

kidney can help even out
potassium levels as
HCTZ lowers levels
Pravastatin (Pravachol) Inhibits HMG-CoA • Myopathy
reductase – this enzyme is • Reduces risk of heart
the rate limiting step in attack/stroke
cholesterol formation • If patients can’t
tolerate simvastatin or
atorvastatin, this one
is often tried
Rosuvastatin (Crestor) Inhibits HMG-CoA • Myopathy
reductase – this enzyme is • Reduces risk of heart
the rate limiting step in attack/stroke
cholesterol formation • Higher intensity statin
Fluticasone + salmeterol Corticosteroid combined • Rinse mouth following
(Advair) with long acting beta use of steroid
agonist – steroid works on (Reduces thrush risk)
inflammation and • Controller medication,
salmeterol opens up the not for rescue
airway • Beta agonist effects –
increased heart rate,
tremor
Trazodone (Desyrel) Possible serotonin type • Dry mouth
activity, not well • Most often used for
understood; histamine sleep, rarely used for
blockade may be straight depression
responsible for sedative • Possibly a little safer in
effect elderly than Z-drugs
like Zolpidem
Alendronate (Fosamax) Inhibits resorption of • Extremely long half life
bone by osteoclasts • Administration
without other drugs,
food – with a plain
glass of water, patient
to remain upright
after
• Usually reassessed
after 5 years of use
Fexofenadine (Allegra) Selective H1 receptor • Sedation
antagonist which leads to • Dry mouth
relief of allergy symptoms • Once daily dosing

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Lovastatin (Mevacor) Inhibits HMG-CoA • Myopathy

reductase – this enzyme is • Reduces risk of heart
the rate limiting step in attack/stroke
cholesterol formation • Risk of rhabdomyolysis
(Associated with all
statins)
Carvedilol (Coreg) Blocks beta-1 receptors • Pulse monitoring
(found primarily in the • Can blunt beta-agonist
heart); prevents activity of activity (potentially
sympathetic nervous exacerbate asthma,
system leading to COPD)
reduction in heart rate • Can block signs of
and BP; has some alpha hypoglycemia
blockade as well (exception sweating)
Paroxetine (Paxil) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Meloxicam (Mobic) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Diazepam (Valium) Enhances GABA activity • Used for acute
which has sedative, management of
hypnotic, anticonvulsant, anxiety/seizure
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly
Valsartan (Diovan) Angiotensin receptor • Hyperkalemia
blocker – prevents the • Alternate to ACE
activity of angiotensin Inhibitor
which is a vasoconstrictor • Less incidence of
cough compared to
ACE inhibitors

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Duloxetine (Cymbalta) Serotonin and • More beneficial for

Norepinephrine reuptake pain than SSRI’s
inhibitor which increases (Neuropathy)
concentrations of both in • Possible increase in
the brain synapses hypertension at high
doses
• GI side effects,
serotonin syndrome
risk
Venlafaxine (Effexor) Serotonin and • More beneficial for
Norepinephrine reuptake pain than SSRI’s
inhibitor which increases (Neuropathy)
concentrations of both in • Possible increase in
the brain synapses hypertension at high
doses
• GI side effects,
serotonin syndrome
risk
Ranitidine (Zantac) Histamine 2 Receptor • Slightly less potent
Antagonist which reduces than the PPI’s
gastric acid secretion • Can accumulate in
leading to relief of kidney disease
heartburn and GI • Tend to work a little
symptoms quicker than the PPI’s
Fluconazole (Diflucan) Inhibits fungal • 3A4 drug interactions
cytochrome P450 enzyme (amiodarone,
14alpha-demthylase phenytoin, warfarin,
etc.)
• GI upset
• Liver concerns
Naproxen (Aleve) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Doxycycline (Vibramycin) Inhibits bacterial protein • Increases sensitivity to
synthesis by binding to sunburn
the 30s ribosomal subunit • Binding interactions
with calcium and iron
• Avoid in pregnancy

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Potassium (Klor-Con) Potassium replacement • Often used for

patients on diuretics
that deplete
potassium
• GI upset
• Often patient do have
trouble swallowing
larger doses (big pills)
– some forms can be
dissolved in water
Amitriptyline (Elavil) Inhibits norepinephrine • Highly anticholinergic
and serotonin reuptake, (sedation, confusion,
leading to increased dry eye, etc.)
concentrations in the • Can be used for pain
synapse syndromes (migraines,
fibromyalgia, etc.)
• Higher risk of cardiac
concerns in overdose
compared to SSRI’s so
less often used for
depression
Lansoprazole (Prevacid) Inhibits H+/K+ ATPase • Short term only
pump in gastric parietal recommended for
cells (reduces hydrogen GERD
ion – stomach acid • Associated with low
concentration in stomach) magnesium and B12
• Most potent acid
blocking medication
class
Pioglitazone (Actos) Decreases insulin • Weight gain
resistance in the • Edema
periphery; leading to • Generally avoid in CHF
greater uptake of glucose patients
into muscle tissue and
lower blood sugar
Methylprednisolone (Medrol) Multiple possible • Suppression of HPA
pathways of reducing axis
inflammation and • Increases blood
suppressing the immune sugars, causes
system (inhibition of insomnia and GI upset
cytokines, chemokines, • Increases risk of
arachidonic acid etc.) osteoporosis

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Allopurinol (Zyloprim) Inhibition of xanthine • Not meant for acute

oxidase which results in gout flares
less production of uric • Rash
acid and lower levels • Can accumulate in
kidney disease
Codeine + APAP (Tylenol #3) codeine - Binds, activates • Addiction/dependence
mu-opioid receptor, risk
Acetaminophen – • Respiratory
suspected to inhibit depression
prostaglandin synthesis • Constipation
which reduces pain
Enalapril (Vasotec) Inhibits angiotensin • Cough
converting enzyme which • Hyperkalemia
ultimately leads to • Used to help protect
reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Carisoprodol (Soma) Not well understood, • Sedation
potential effects at GABA • Controlled substance
receptors • Dizziness
Tamsulosin (Flomax) Blocks alpha-1a receptors • Dizziness, low blood
which causes smooth pressure
muscle relaxation of the • Work fairly quickly
bladder neck and prostate compared to 5 alpha
reductase inhibitors
• Rare risk of floppy iris
syndrome in patients
having eye surgery
Ezetimibe (Zetia) Inhibits intestinal • GI upset
absorption of cholesterol • Not great evidence
leading to lower levels that indicates it
reduces the risk of
heart attack and
stroke
• 2nd or third line agent
for lowering
cholesterol (statins are
drug of choice)
Quetiapine (Seroquel) Blockade of dopamine 2 • Sedation and
receptors is primary orthostasis risk
mechanism • Extrapyramidal
symptoms

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• Metabolic syndrome
and QTc prolongation
risk
Levofloxacin (Levaquin) Inhibits DNA gyrase in • Risk of spontaneous
bacteria which prevents tendonitis or tendon
DNA separation and cell rupture
division • Dose adjustments
with poor kidney
function
• Binding interaction
with iron and calcium
can reduce absorption
Fenofibrate (Tricor) Activates lipoprotein • Target for elevated
lipase and reduces triglycerides, SE =
synthesis of apoprotein C- myopathy
3; both of these • Statins reserved for
mechanisms work to cardiovascular risk
lower cholesterol reduction and LDL
lowering
• Elevated triglycerides
increase risk of
pancreatitis
Clonidine (Catapres) Stimulates centrally acting • Dry mouth
alpha-2 receptors causing • Dizziness, CNS changes
reduced sympathetic • Generally avoided in
outflow which lowers BP the elderly
and pulse
Promethazine (Phenergan) Possible anticholinergic • Used for motion
(blocks acetylcholine) and sickness, nausea and
antihistamine effects, also vomiting
may mildly block • Sedating
dopamine receptors • Anticholinergic side
effects
Ethinyl estradiol + Drosperinone Oral contraceptive – • DVT/PE
(Yaz) estrogen prevents • Hypertension
ovulation and reduces risk • Headache/GI
of pregnancy symptoms
Sildenafil (Viagra) Inhibition of • Low blood pressure
phosphodiesterace-5 • Rare vision adverse
(PDE-5) causes smooth effect
muscle relaxation and • Avoid using with
increased blood flow to nitrates
the penis

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Celecoxib (Celebrex) Selective inhibition of • GI side effects

COX-2 leads to reduced generally less than
formation of arachidonic traditional NSAIDs
acid and prostaglandins • Edema risk
• Kidney risk still the
same as traditional
NSAIDs
Loratadine (Claritin) Selective H1 receptor • Sedation
antagonist which leads to • Dry mouth
relief of allergy symptoms • Once daily dosing
Oxycodone (OxyContin) Oxycodone - Binds, • Addiction/dependence
activates mu-opioid risk
receptor • Respiratory
depression
• Constipation
Glargine (Lantus, Basaglar) Long acting insulin analog • Weight gain
• Hypoglycemia risk
• Dose once daily and
targets fasting blood
sugars
Mometasone (Nasonex) Stimulates glucocorticoid • May work a little
receptors which leads to better if taken
reduced inflammation routinely
• Nose bleeding,
irritation
• Used in allergic rhinitis
Pregabalin (Lyrica) Not well known; • Sedation
suspected that it might • Dizziness
bind the alpha2-delta • Weight gain
subunits leading to a
reduction in neuronal
excitability
Amaryl (Glimepiride) Stimulates pancreatic • Weight gain
beta cells to release • Hypoglycemia
insulin • Inexpensive
Temazepam (Restoril) Enhances GABA activity • Shorter half-life than
which has sedative, others, so may see this
hypnotic, anticonvulsant, one used for sleep
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly

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Conjugated Estrogen (Premarin) Replacement estrogen in • DVT/PE

postmenopausal women • Hypertension
who experience • Increased risk of
symptoms like hot flashes, breast cancer
vaginal dryness, etc.
Folic acid (Folvite) Supplement of folic acid • Tolerability is usually
fine
• Given with
methotrexate for
RA/psoriasis etc.
• Deficiency can lead to
anemia
Spironolactone (Aldactone) Aldosterone antagonist • Hyperkalemia
that blocks the effects of • Gynecomastia (Man-
aldosterone, leading to boobs)
lower blood pressure and • Monitor kidney
a diuretic effect function
Digoxin (Lanoxin) Inhibits sodium, • Used in atrial
potassium ATPase leading fibrillation or CHF
to an increase in the force • Toxicity signs include
of contraction of the heart GI, CNS changes, visual
changes, and weight
loss
• Can accumulate in
kidney disease and
cause more toxicity
with low potassium
levels
Isosorbide Mononitrate (Imdur) Increase in nitric oxide • Headache
leads to venous and • Dizziness
arterial dilation • Can become tolerate
to effects, usually
recommended to have
a nitrate free period
during the day
Cefdinir (Omnicef) Inhibits penicillin binding • Diarrhea
protein which prevents • Nausea/Vomiting
bacterial cell wall • broader spectrum
synthesis coverage than
cephalexin

Ramipril (Altace) Inhibits angiotensin • Cough

converting enzyme which • Hyperkalemia

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

ultimately leads to • Used to help protect

reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Triamcinolone (Nasacort) Stimulates glucocorticoid • May work a little
receptors which leads to better if taken
reduced inflammation routinely
• Nose bleeding,
irritation
• Used in allergic rhinitis
Losartan (Cozaar) Angiotensin receptor • Hyperkalemia
blocker – prevents the • Alternate to ACE
activity of angiotensin Inhibitor
which is a vasoconstrictor • Less incidence of
cough compared to
ACE inhibitors
Methylphenidate (Concerta) Prevents catecholamine • Weight loss
reuptake in CNS synapses • Insomnia
leading to increased • Anxiety, tachycardia,
dopamine and and increased BP
norepinephrine
Glyburide (Diabeta) Stimulates pancreatic • Weight gain
beta cells to release • Hypoglycemia
insulin • Inexpensive
Valacyclovir (Valtrex) Inhibits DNA Polymerase • Treatment of herpes
which prevent viral and varicella viruses
replication • GI upset
• Prodrug; converted to
acyclovir
Oseltamivir (Tamiflu) Inhibits influenza virus • GI side effects
neuraminidase, which • Dose adjusted based
likely alters replication or on kidney function
release of budding viruses • Used in treatment and
prophylaxis of
influenza
Tiotropium (Spiriva) Long acting • One of the drugs of
antimuscarinic choice in COPD
(anticholinergic) that maintenance therapy
binds to M3 receptors • Not intended for acute
which relaxes smooth relief (rescue) of
muscle leading to symptoms
bronchodilation • Dry mouth

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Benazepril (Lotensin) Inhibits angiotensin • Cough

converting enzyme which • Hyperkalemia
ultimately leads to • Used to help protect
reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Lamotrigine (Lamictal) Inhibits voltage sensitive • Can be used for
sodium channels which seizures or mood
stabilizes neuronal disorders like bipolar
membranes • Drug interaction with
valproic acid
• Rash (possibly severe
Stephen Johnson’s
Syndrome)
Olmesartan (Benicar) Angiotensin receptor • Hyperkalemia
blocker – prevents the • Alternate to ACE
activity of angiotensin Inhibitor
which is a vasoconstrictor • Less incidence of
cough compared to
ACE inhibitors
Donepezil (Aricept) Acetylcholinesterase • Weight loss
Inhibitor which helps • Diarrhea
increase acetylcholine in • Does not reverse
the brain (Remember dementia
than anticholinergics can
cause confusion)
Risperidone (Risperdal) Blockade of dopamine 2 • Sedation and
receptors is primary orthostasis risk
mechanism • Extrapyramidal
symptoms
• Metabolic syndrome
and QTc prolongation
risk
Glipizide (Glucotrol) Stimulates pancreatic • Weight gain
beta cells to release • Hypoglycemia
insulin • Inexpensive
Amphetamine salts (Adderall) Prevents catecholamine • Weight loss
reuptake in CNS synapses • Insomnia
leading to increased • Anxiety, tachycardia,
dopamine and and increased BP
norepinephrine
Aripiprazole (Abilify) Blockade of dopamine 2 • Indicated for
receptors is primary augmentation of
mechanism

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depression as well as
schizophrenia
• Extrapyramidal
symptoms
• Metabolic syndrome
and QTc prolongation
risk
Verapamil (Verelan) Non-dihydropyridine; • Used in Afib, HTN, or
Blocks the entry of chronic headaches
calcium into smooth • Monitor pulse
muscle and heart, causing • Edema
vasodilation and slowing
of heart rate
Clindamycin (Cleocin) Bind 50s subunit of • GI side effects
bacterial ribosome which • Higher risk of colitis
prevents protein synthesis and C.diff
• Good for anaerobic
bacteria
Metronidazole (Flagyl) Disrupts bacterial DNA • Interaction with
synthesis warfarin
• Avoid alcohol when
taking medication
• Used for Anaerobic
bacteria
Ethinyl Estradiol + Norgestimate Oral contraceptive – • DVT/PE
(Ortho Tri-Cyclen) estrogen prevents • Hypertension
ovulation and reduces risk • GI/Headache
of pregnancy
Tadalafil (Cialis) Inhibition of • Low blood pressure
phosphodiesterace-5 • Rare vision adverse
(PDE-5) causes smooth effect
muscle relaxation and • Avoid using with
increased blood flow to nitrates
the penis
Phentermine (Adipex) Sympathetic amine – • Used for weight loss
increases adrenaline, • Monitor for cardiac
dopamine, and possibly concerns; increase in
serotonin BP and pulse
• Can cause insomnia or
anxiety
Hydroxyzine (Vistaril) H1 receptor antagonist • Anticholinergic effects
which leads to relief of • Used for anxiety

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allergy symptoms and • Considered a 1st

causes sedation generation
antihistamine
(sedating)
Diclofenac (Cataflam) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Metoclopramide (Reglan) Inhibition of D2 receptors • Risk of movement
in chemoreceptor trigger disorders like EPS
zone • Often used in
gastroparesis
• Can exacerbate
Parkinson’s disorder
Gemfibrozil (Lopid) Not well known - targets • Risk of myopathy
triglycerides and can • Interaction with
possibly help raise HDL statins (increases risk
of myopathy and
rhabdomyolysis)
• Indicated for
significantly high
triglycerides
Diltiazem (Cardizem) Non-dihydropyridine; • Used in Afib, HTN, or
Blocks the entry of chronic headaches
calcium into smooth • Monitor pulse
muscle and heart, causing • Edema
vasodilation and slowing
of heart rate
Divalproex (Depakote) Not well known, possibly • Sedation
increasing GABA in the • Weight gain
brain • Ataxia, CNS changes
Nitrofurantoin (Macrobid) Altered by bacterial • GI upset
flavoproteins to reactive • Nitrofurantoin lung
intermediates which (rare)
breakdown bacterial • Avoid use if suspected
ribosomal proteins kidney/systemic
infection, good for UTI
only

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Mirtazapine (Remeron) Multiple potential • Weight gain

mechanisms include • Sedating
blocking alpha-2 • Classified as
receptors, as well as antidepressant but
serotonin subtypes and often used for
histamine blockade sleep/sedative
properties
Latanoprost (Xalatan) Prostaglandin agonist • Used for glaucoma
which increases aqueous • Will help eye lashes
humor outflow and grow
reduces intraocular • Can alter color of the
pressure eye
Sitagliptin (Januvia) DPP-4 inhibitor – DPP-4 • Rare pancreatitis risk
breaks down incretins like • GI side effects
GLP-1 which are • Low risk of
hormones that can reduce hypoglycemia when
blood sugars by used alone
promoting fullness
Acyclovir (Zovirax) Inhibits DNA Polymerase • Treatment of herpes
which prevent viral and varicella viruses
replication • GI upset
• Can accumulate in
kidney disease
Doxazosin (Cardura) Blocks alpha receptors • Orthostasis risk
which causes smooth • Not selective for
muscle relaxation of the bladder so can be
bladder neck and prostate used for HTN and BPH
and vasodilation • Usually dosed at night
Eszopiclone (Lunesta) Enhances GABA activity • Used for insomnia
which has sedative, only
hypnotic effects • Dizziness/sedation
• Generally avoid in
elderly
Niacin (Niaspan) Inhibition of triglyceride • Can cause flushing
synthesis by stimulating • Increases uric acid
intracellular Apo-B • Option in reducing
degradation and reduces triglycerides
release of VLDL and LDL
Propranolol (Inderal) Non-selective beta • Pulse monitoring
blocker; reduced heart • Can blunt beta-agonist
rate, blood pressure; may activity (potentially
have higher risk for exacerbate asthma,
adverse effects due to COPD)
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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

non-selectivity (also lot of • Can block signs of

unique uses – tremor, hypoglycemia
esophageal varices, (exception sweating)
migraines)
Buprenorphine/naloxone Partial opioid agonist that • Possible opioid like
(Suboxone) has a peak effect on effects to a certain
stimulating the mu extent
receptors combine with a • Prevents full opioid
full opioid antagonist agonists from binding
(naloxone), used to treat in management of
opioid use disorder addiction
• Need a special
prescribing certificate
to prescribe for opioid
use disorder
Bupropion (Wellbutrin) Inhibits reuptake of • Used in smoking
norepinephrine, cessation
dopamine and possibly • Avoid in patients with
serotonin to help treat seizures
depression • Can contribute to
insomnia
Guaifenesin (Robitussin) Increases volume and • Well tolerated
reduces thickness of • Questionable
mucous (expectorant) effectiveness
• Take with lots of water
Topiramate (Topamax) Blocks voltage dependent • Cognitive slowing,
sodium and calcium confusion
channels, may have some • Sedation
activity on GABA as well • Antiseizure
medication, but often
used for migraines
Buspirone (Buspar) Serotonin partial agonist • Takes a while to work
and 5HT1A receptors; • Used in anxiety
possible activity at • Pretty well tolerated
dopamine receptors as compared to
well benzodiazepines
especially in elderly
Meclizine (Antivert) Antihistamine effects at • Sedation
H1 receptors • Anticholinergic side
effects
• Primarily used for
nausea and motion
sickness
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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Tolterodine (Detrol) Antagonist at muscarinic • Dry mouth

(M2 and M3) receptors • Confusion
which helps in the • Can exacerbate
management of urinary retention
overactive bladder
Lisdexamfetamine (Vyvanse) Prevents catecholamine • Weight loss
reuptake in CNS synapses • Insomnia
leading to increased • Anxiety, tachycardia,
dopamine and and increased BP
norepinephrine
Quinapril (Accupril) Inhibits angiotensin • Cough
converting enzyme which • Hyperkalemia
ultimately leads to • Used to help protect
reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Mupirocin (Bactroban) Inhibits bacterial protein • Topical antibiotic
and RNA synthesis • Skin irritation
• MRSA coverage (but
only as a topical
agent)
Methotrexate (Rheumatrex) Inhibition of dihydrofolate • Low doses used for RA
reductase (anticancer) • Need to supplement
also is classified as a with folic acid
disease modifying anti- • Dose once weekly and
rheumatic drug (DMARD) monitor liver function
Polyethylene Glycol (Miralax) Osmotic laxative that • Diarrhea
draws moisture into the • Mix with 8oz. of fluid
bowel to help relieve • Rare possibility for
constipation electrolyte
abnormalities
Fentanyl (Duragesic) Binds, activates mu-opioid • Patch formulation
receptor • NOT for acute pain
• Very slow onset/offset
Benzonatate (Tessalon Pearls) Anesthetic type effects • Sedation
which can numb the • GI upset
throat and suppress • Make sure you aren’t
cough masking ACE inhibitor
cough
Irbesartan (Avapro) Angiotensin receptor • Hyperkalemia
blocker – prevents the • Alternate to ACE
activity of angiotensin Inhibitor
which is a vasoconstrictor

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

• Less incidence of
cough compared to
ACE inhibitors
Albuterol + Ipratropium Combination beta-agonist • Dry mouth
(Duonebs, Combivent) and short acting • Tachycardia
anticholinergic • Tremor
Ibandronate (Boniva) Inhibits resorption of • Extremely long half life
bone by osteoclasts • Administration
without other drugs,
food – with a plain
glass of water, patient
to remain upright
after
• Usually reassessed
after 5 years of use
Methadone (Methadose) Binds, activates mu-opioid • Addiction/dependence
receptor risk
• Respiratory
depression
• Constipation
Clotrimazole + Betamethasone Combination antifungal • Fungal infections can
(Lotrisone) and topical corticosteroid take a while to treat
• Skin thinning with
prolonged use
• Skin irritation
Sumatriptan (Imitrex) Serotonin agonist at • Caution in patients at
5HT1D receptors – high risk of
thought to cause cardiovascular
vasoconstriction, but concerns
maybe a little more • Treatment of acute
unknown now? migraine
• CNS adverse effects
like confusion
Nifedipine (Procardia) Blocks the entry of • Edema
calcium into smooth • No action on the heart
muscle, causing (compared to
vasodilation diltiazem, verapamil)
• Used to help prevent
angina and manage
blood pressure
Famotidine (Pepcid) Histamine 2 Receptor • Slightly less potent
Antagonist which reduces than the PPI’s
gastric acid secretion
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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

leading to relief of • Can accumulate in

heartburn and GI kidney disease
symptoms • Tend to work a little
quicker than the PPI’s
Finasteride (Proscar) Inhibits 5 alpha reductase • Sexual dysfunction
which prevent side effect
dihydrotestosterone • Can be used for hair
formation which growth in baldness
contributes to • Takes months to
enlargement of the shrink prostate
prostate
Ferrous Sulfate (Feosol) Iron replacement • Deficiency can cause
anemia and RLS
• GI upset
• Constipation
Terazosin (Hytrin) Blocks alpha receptors • Orthostasis risk
which causes smooth • Not selective for
muscle relaxation of the bladder so can be
bladder neck and prostate used for HTN and BPH
and vasodilation • Usually dosed at night
Fish Oil (Lovaza) Not well understood, but • Burping/fish taste
can help reduce • GI upset
triglycerides and increase • Rare potential to
HDL interfere with platelet
aggregation (usually
help around surgery)
Tizanidine (Zanaflex) Central alpha-2 receptor • Sedation
agonist which inhibits • Dizziness
motor neurons and • Maybe a little better
reduces spasticity tolerated in the
elderly than
cyclobenzaprine
Risedronate (Actonel) Inhibits resorption of • Extremely long half life
bone by osteoclasts • Administration
without other drugs,
food – with a plain
glass of water, patient
to remain upright
after
• Usually reassessed
after 5 years of use

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Memantine (Namenda) Inhibition of N-methyl-d- • CNS side effects like

aspartate (NMDA) sedation, confusion
receptors • Dose adjusted in
kidney impairment
• Used in delaying
progression of
dementia
Insulin Aspart (Novolog) Rapid acting insulin • Hypoglycemia
analog • Weight gain
• Targets post-prandial
elevations in blood
sugars
Aspirin Non-selective inhibitor of • Risk of Reye’s
cyclooxygenase (COX) – syndrome in pediatrics
which ultimately reduces • Typically used for
the production of cardiovascular
prostaglandins which are protection as low dose
involved in 81-325 mg once daily
pain/inflammation • GI bleed risk
Clobetasol (Temovate) Topical corticosteroid that • Skin thinning
can reduce inflammation, • Possible systemic
redness and itching effects with large
quantities over longer
periods of times
• Used for psoriasis and
dermatitis
Bisoprolol (Zebeta) Blocks beta-1 receptors • Pulse monitoring
(found primarily in the • Can blunt beta-agonist
heart); prevents activity of activity (potentially
sympathetic nervous exacerbate asthma,
system leading to COPD)
reduction in heart rate • Can block signs of
and BP hypoglycemia
(exception sweating)
Nitroglycerin (NitroStat) Relaxes vascular smooth • Dizziness
muscle and dilates • Headache
arteries and veins • Use for acute chest
pain (angina);
administer 3 tablets
over 15 minutes, call
911 if still having chest
pain

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Varenicline (Chantix) Partial nicotine agonist • Vivid dreams and

which prevents nicotine nightmares
from binding and reduces • GI upset
reward sensation from • Insomnia
smoking
Raloxifene (Evista) Selective estrogen • DVT/PE risk
receptor modifier; blocks • Hot flashes
activity at some estrogen • Vaginal dryness
receptors and helps at
others in management of
reducing breast cancer
risk and can help in
osteoporosis
Olanzapine (Zyprexa) Blockade of dopamine 2 • Sedation and
receptors is primary orthostasis risk
mechanism • Extrapyramidal
symptoms
• Metabolic syndrome
and QTc prolongation
risk
Ondansetron (Zofran) Inhibits 5-HT3 (serotonin) • Rare QTc prolongation
receptors in the risk
chemoreceptor trigger • Often used in patient
zone to reduce nausea receiving emetogenic
chemotherapy
• CNS side effects
Ropinirole (Requip) Dopamine agonist that • Edema
can be used for • Obsessive behaviors
Parkinson’s where there is like excessive
a shortage of dopamine; gambling, eating
more commonly used in • GI side effects
RLS
Dicyclomine (Bentyl) Anticholinergic that can • Constipation
be helpful in managing • Dry eyes/dry mouth
diarrhea and relaxing • Confusion
smooth muscle in patients
with GI spasms and pain
Insulin Lispro (Humalog) Rapid acting insulin • Hypoglycemia
analog • Weight gain
• Targets post-prandial
blood sugars
Nabumetone (Relafen) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

which ultimately reduces • Exacerbates

the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Clarithromycin (Biaxin) Binds 50s ribosomal • Numerous CYP3A4
subunit and prevents drug interactions
protein synthesis (inhibitor)
• GI adverse effects
• Rare risk for QTc
prolongation
Lidocaine patch (Lidoderm) Binds to neuronal • Local pain relieving
membrane receptors and effects
inhibits sodium ion • 12 hours on/12 off
influxes and prevents cell • Systemic side effects
action potential usually minimal
Dutasteride (Avodart) Inhibits 5 alpha reductase • Sexual dysfunction
which prevent side effect
dihydrotestosterone • Fatigue
formation which • Takes months to
contributes to shrink prostate
enlargement of the
prostate
Phenytoin (Dilantin) Not well understood, • Ataxia, CNS changes
possibly blocking voltage with toxicity
gated sodium channels • Highly protein bound
drug, low albumin can
increase toxicity risk
• Enzyme inducing type
effect on CYP3A4 and
others
Colchicine (Colcrys) Binds to tubulin and • Diarrhea
prevents microtubule • Rare indication for
polymerization – reduces prophylaxis and
a gout flare and prevents treatment
it as well • Dose adjusted with
poor kidney function
Moxifloxacin (Avelox) Inhibits DNA gyrase in • Risk of spontaneous
bacteria which prevents tendonitis or tendon
DNA separation and cell rupture
division • Considered a
respiratory
fluoroquinolone only

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

• Binding interaction
with iron and calcium
can reduce absorption
Baclofen (Lioresal) Not well understood; • Used in management
skeletal muscle relaxant of spasms
• Sedation, confusion
• Can be used on an as
needed basis
Hydroxychloroquine (Plaquenil) Not well understood, • Eye exams required
originally was used as • LFT/CBC monitoring
antimalarial drug, in US, • Takes a while to begin
primarily used as DMARD working (not a quick
in RA and Lupus acting medication in
RA or Lupus)
Enoxaparin (Lovenox) Increases activity of • Injection
antithrombin that • Bleed risk
ultimately inactivates • Risk of heparin
factor 10a; some activity induced
against clotting factor 2a thrombocytopenia
(thrombin), but less than
heparin
Atomoxetine (Strattera) Possible inhibition of • Insomnia, anxiety,
norepinephrine weight loss
transporter – used in • Not a controlled
ADHD substance (compared
to methylphenidate
and amphetamine
derivatives)
• Can worsen agitation,
irritability and possibly
cause suicidal
thoughts
Diphenhydramine (Benadryl) H1 receptor antagonist • Anticholinergic effects
which leads to relief of • Used for itching, mild
allergy symptoms and to moderate allergic
causes sedation reactions
• Over the counter
availability
Ketoconazole (Nizoral) Inhibits fungal • 3A4 drug interactions
cytochrome P450 enzyme (amiodarone,
14alpha-demthylase phenytoin, warfarin,
etc.)

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

• Primarily used as
topical agent (if so,
side effects are pretty
minimal)
• Liver concerns
Nortriptyline (Pamelor) Inhibits norepinephrine • Highly anticholinergic
and serotonin reuptake, (sedation, confusion,
leading to increased dry eye, etc.)
concentrations in the • Can be used for pain
synapse syndromes (migraines,
fibromyalgia, etc.)
• Higher risk of cardiac
concerns in overdose
compared to SSRI’s so
less often used for
depression
Benztropine (Cogentin) Anticholinergic that is • Anticholinergic side
centrally acting and can effects like dry eyes,
inhibit dopamine uptake dry mouth, confusion,
in the synapse – used to sedation
prevent EPS from • If patients are
antipsychotics and benefitting from
possible benefit in antipsychotics but
Parkinson’s experiencing EPS, this
drug may be used
• Not well tolerated in
elderly
Minocycline (Minocin) Inhibits bacterial protein • Increases sensitivity to
synthesis by binding to sunburn
the 30s ribosomal subunit • Binding interactions
with calcium and iron
• Most often used for
skin disorders (i.e.
acne)
Pantoprazole (Protonix) Inhibits H+/K+ ATPase • Short term only
pump in gastric parietal recommended for
cells (reduces hydrogen GERD
ion – stomach acid • Associated with low
concentration in stomach) magnesium and B12
• Most potent acid
blocking medication
class

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Cefuroxime (Ceftin) Inhibits penicillin binding • Diarrhea

protein which prevents • Nausea/Vomiting
bacterial cell wall • broader spectrum
synthesis coverage than
cephalexin

Oxybutynin (Ditropan) Antagonist at muscarinic • Dry mouth

receptors which helps in • Confusion
the management of • Can exacerbate
overactive bladder urinary retention
Levetiracetam (Keppra) Not well known; possible • Sedation
anti-seizure activity due to • Confusion
inhibition of presynaptic • Can accumulate in
calcium channels kidney disease
Hydralazine (Apresoline) Not well understood, • Dosed multiple times
direct vasodilator, reduces per day
blood pressure • Can exacerbate, cause
Lupus
• Low blood pressure,
dizziness risk
Liraglutide (Victoza) Acts like human incretin • Weight loss effect as
(GLP-1 agonist) which can well as lowering blood
aid in promoting fullness, sugars
decrease appetite and • Injection, GI side
possibly stimulate insulin effects
release • Avoid in patients
who’ve had thyroid
cancer
Prasugrel (Effient) Blocks binding of ADP to • Bleed risk
the P2Y12 receptor; by • Often used in
doing this, it prevents combination with
platelet aggregation aspirin following
stenting
• Costlier than
clopidogrel
Mirabegron (Myrbetriq) Acts as an agonist at Beta- • Increase in blood
3 type receptors which pressure
causes detrusor smooth • Increase heart rate
muscle relaxation and can • Unique mechanism
help with overactive from anticholinergic
bladder medication used for
OAB

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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

Canagliflozin (Invokana) Inhibits SGLT-2 which • Risk of urinary tract

helps keep glucose in the infections
urine – so ultimately • Mild diuretic effect
reduces blood sugar • Monitor kidney
function
Apixaban (Eliquis) Inhibits clotting factor 10a • Dose adjustments
to prevent blood clots and based on age, weight,
stroke and kidney function
• Alternative to warfarin
without routine INR
requirement
• Bleed risk
Tradjenta (Linagliptin) DPP-4 inhibitor – DPP-4 • Rare pancreatitis risk
breaks down incretins like • GI side effects
GLP-1 which are • Low risk of
hormones that can reduce hypoglycemia when
blood sugars by used alone
promoting fullness
Dulaglutide (Trulicity) Acts like human incretin • Weight loss effect as
(GLP-1 agonist) which can well as lowering blood
aid in promoting fullness, sugars
decrease appetite and • Injection (once
possibly stimulate insulin weekly), GI side
release effects
• Avoid in patients
who’ve had thyroid
cancer
Morphine (MS Contin) Binds, activates mu-opioid • Addiction/dependence
receptor risk
• Respiratory
depression
• Constipation
Empagliflozin (Jardiance) Inhibits SGLT-2 which • Risk of urinary tract
helps keep glucose in the infections
urine – so ultimately • Mild diuretic effect
reduces blood sugar • Monitor kidney
function
Rivaroxaban (Xarelto) Inhibits clotting factor 10a • Dose adjustments
to prevent blood clots and based on age, weight,
stroke and kidney function
• Alternative to warfarin
without routine INR
requirement
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 REAL LIFE PHARMACOLOGY PODCAST – TOP 200 STUDY GUIDE

• Bleed risk
Amiodarone (Cordarone) Class 3 antiarrhythmic; • LFT monitoring
likely inhibits potassium • TSH monitoring
and sodium channels • Can cause pulmonary
which increase the fibrosis
duration of ventricular
and atrial muscle
contraction
Carbamazepine (Tegretol) Sodium channel • Potent enzyme
antagonist used in the inducer, lots of drug
management of seizure, interactions
bipolar, and trigeminal • LFT monitoring
neuralgia • Hyponatremia risk

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