Pharmacology Flash Cards

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Receptor Subtype Alpha1 Alpha2 Beta1 Beta2 Dopamine Location Eye

Arterioles (skin, viscera, mucous membranes)

Veins

Sex organs, male

Bladder neck and prostatic capsule Presynaptic nerve terminals

Heart

Kidney

Arterioles (heart, lung, and skeletal mucle) Bronchi Uterus Liver Skeletal muscle Kidney

Response to Receptor Activation Mydriasis—wide eyed with fear Constriction

Constriction Ejaculation Contraction

Inhibition of transmitter release—decreases sympathetic nervous system (SNS) out-flow to the blood vessels and heart Increased rate, force of contraction, and AV

conduction velocity Renin release—RAS Dilation Dilation Relaxation Glycogenolysis

Enhanced contraction, glycogenolysis Dilation of kidney vasculature Drug Receptor Types

Functions of Peripheral Adrenergic Receptor Subtypes

Receptor Subtype Nicotinicn Nicotinicm Muscarinic Location

All autonomic nervous system ganglia and the adrenal medulla

Neuromuscular junction All parasympathetic target organs:

Eye Heart Lung Bladder GI tract Sweat glands Sex organs Blood vessels

Response to Receptor Activation Stimulation of parasympathetic and

sympathetic postganglionic nerves and release of epinephrine from the adrenal medulla

Contraction of skeletal muscle Miosis Decreased rate Constriction of bronchi Promotion of secretions Voiding Salivation

Increases gastric secretions, intestinal tone, and motility

Defecation

Generalized sweating Erection

Vasodilation Functions of Peripheral Cholinergic Receptor Subtypes

Drug Endings Drug Endings -zosin -olol, -lol -zepam, -zolam -pril -artan -dipine -statin -ase, -plase -parin -sone -dronate Drug Classification Alpha-adrenergic blocker Beta-adrenergic blocker Benzodiazepine (BZD)

Angiotensin-converting enzyme (ACE) inhibitor Angiotensin-receptor blocker (ARB)

Calcium channel blocker Lipid-lowering drug Thrombolytic Anticoagulant Corticosteroid

Bisphosphonate for osteoporosis

Drug Example prazosin metoprolol diazepam, alprazolam lisinopril candesartan amlodipine atorvastatin alteplase enoxaparin prednisone alendronate Drug Endings—cont’d Drug Endings -terol -tidine -prazole -cillin -cef, -ceph -cycline -floxacin -thromycin -micin, -mycin -azole Drug Classification Bronchodilator

Histamine2blocker–acid reducer Protein pump inhibitor–acid reducer Penicillin antibiotic Cephalosporin antibiotic Tetracycline antibiotic Fluoroquinolone antibiotic Macrolide antibiotic Aminoglycoside antibiotic Antifungal Drug Example albuterol cimetidine omeprazole amoxicillin cefazolin tetracycline levofloxacin azithromycin gentamycin itraconazole Continued

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BETHANECHOL (URECHOLINE)

Muscarinic Agonist

Activates muscarinic receptors

Causes contraction of the detrusor muscle of the bladder Uses

Postoperative urinary retention Adverse Effects Hypotension Bradycardia, dysrhythmias Bronchoconstriction GI effects

BETHANECHOL (URECHOLINE)

Muscarinic Agonist

ATROPINE

Muscarinic Antagonist (Anticholinergic)

Blocks muscarinic receptors

Increases heart rate

Decreases salivary, bronchial, sweat, and acid-secreting cell secretions Relaxes bronchial smooth muscles

Decreases bladder tone and GI motility Dilates pupils (mydriasis)

Uses

Preanesthesia to prevent bradycardia, treatment of bradycardia Dilation of pupil for ocular examination or surgery

Intestinal hypertonicity and hypermotility Antidote for muscarinic-agonist poisoning

Adverse Effects

Blurry vision, urinary retention, dry mouth, constipation, tachycardia Increases intraocular pressure

ATROPINE

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NEOSTIGMINE (PROSTIGMINE)

Reversible Cholinesterase Inhibitor

Prevents the degradation of acetylcholine (ACh) Enhances the effect of ACh to stimulate skeletal muscle

Uses Myasthenia gravis

Reversal of neuromuscular blockade in postoperative patients Adverse Effects

Excessive glandular secretions, increased GI motility Urinary urgency, bradycardia, sweating, and miosis

Cholinergic crisis—treat with atropine

NEOSTIGMINE (PROSTIGMINE)

Reversible Cholinesterase Inhibitor

SUCCINYLCHOLINE

Depolarizing Neuromuscular Blocker

Causes paralysis of muscle by preventing repolarization

Uses

Muscle relaxation during endotracheal intubation Used for short operative procedures

Adverse Effects

Prolonged paralysis in genetically determined individuals Malignant hyperthermia—treat with dantrolene

Muscle pain, hyperkalemia

SUCCINYLCHOLINE

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PHENYLEPHRINE

Adrenergic Agonist

Activates alpha1receptors

Constricts blood vessels of the skin, viscera, and mucous membranes Uses

Treatment of nasal congestion Delay of anesthetic absorption Dilation of the pupil for ocular exam

Adverse Effects Hypertension Necrosis

PHENYLEPHRINE

Adrenergic Agonist

EPINEPHRINE

Adrenergic Agonist (Catecholamine)

Activates all four adrenergic receptors—alpha1, alpha2, beta1, and beta2

Pupil dilation, arterial and venous vasoconstriction Increases heart rate and force of contraction

Bronchial dilation, glycogenolysis, enhanced muscle contraction Uses

Cardiac arrest, heart failure, and anaphylactic shock AV heart block and asthma

Delays absorption of local anesthetic and controls superficial bleeding Reduces nasal congestion

Dilates pupil for eye procedures Adverse Effects

Hypertension, tachycardia, and dysrhythmias Angina, necrosis following extravasation

Hyperglycemia in diabetic patients

EPINEPHRINE

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PROPRANOLOL (INDERAL)

Adrenergic Antagonist

Noncardioselective Beta Blocker

Blocks beta1and beta2receptors

Reduces heart rate, decreases force of ventricular contraction Decreases conduction through AV node, decreases cardiac output

Suppresses renin, bronchoconstriction Uses

Angina, hypertension, cardiac dysrhythmias

Myocardial infarction, heart failure, hyperthyroidism, glaucoma Adverse Effects

Bradycardia, reduced cardiac output, AV heart block Rebound cardiac excitation, bronchoconstriction

Inhibition of glycogenolysis, CNS effects Not used in patients with asthma or diabetes

PROPRANOLOL (INDERAL)

Adrenergic Antagonist

Noncardioselective Beta Blocker

METOPROLOL (LOPRESSOR, TOPROL XL)

Adrenergic Antagonist

Cardioselective Beta Blocker

Blocks cardiac beta1receptors

Reduces heart rate, decreases force of ventricular contraction Decreases conduction through AV node, decreases cardiac output

Suppresses renin

Does not block beta2receptors (no bronchoconstriction)

Not likely to inhibit glycogenolysis Preferred for patients with asthma or diabetes

Uses

Hypertension, angina pectoris, heart failure Adverse Effects

Bradycardia, reduction of cardiac output, AV heart block

METOPROLOL (LOPRESSOR, TOPROL XL)

Adrenergic Antagonist

Cardioselective Beta Blocker

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PRAZOSIN (MINIPRESS)

Adrenergic Antagonist

Alpha blocker

Blocks alpha1receptors

Dilates arteries and veins

Relaxes smooth muscle in the bladder neck and prostatic capsule Uses

Hypertension Benign prostatic hypertrophy

Adverse Effects

Orthostatic hypotension, reflex tachycardia Inhibition of ejaculation

Nasal congestion

Use with sildenafil (Viagra), other drugs for erectile dysfunction, can lead to hypotension

PRAZOSIN (MINIPRESS)

Adrenergic Antagonist

Alpha Blocker

CLONIDINE (CATAPRES)

Centrally Acting Alpha

2

Agonist

Antihypertensive Drug

Activates alpha2receptors in the CNS

Reduces sympathetic flow to the heart and blood vessels Reduces stimulation of adrenergic receptors in the periphery Net effect of cardiac suppression and vasodilation is decreased

blood pressure Uses Hypertension Adverse Effects

Hypotension

Bradycardia, decrease in cardiac output Drowsiness, dry mouth

Rebound hypertension in response to abrupt withdrawal Fetal harm

CLONIDINE (CATAPRES)

Centrally Acting Alpha

2

Agonist

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LEVODOPA/CARBIDOPA (SINEMET)

Dopaminergic Agent

Levodopa increases synthesis of dopamine in the striatum Carbidopa enhances the effect of levodopa

Uses

Reduces symptoms of Parkinson’s disease Adverse Effects

Effects take several months to develop Loss of effect occurs over time

Nausea, vomiting, dyskinesias Postural hypotension, psychosis Dark sweat and urine, may activate melanoma

LEVODOPA/CARBIDOPA (SINEMET)

Dopaminergic Agent

DONEPEZIL (ARICEPT)

Cholinesterase Inhibitor

Prevents the breakdown of ACh Increases ACh at cholinergic synapses May slow progression of Alzheimer’s disease (AD)

Some improvement of cognitive function Uses

Alzheimer’s disease (AD) Adverse Effects Cholinergic effects

Nausea, vomiting, dyspepsia, diarrhea Bradycardia, bronchoconstriction

DONEPEZIL (ARICEPT)

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PHENYTOIN (DILANTIN)

Antiepileptic Drug (AED)

Inhibits entry of sodium into neurons Suppresses action potential of neurons

Uses Epilepsy Adverse Effects

Nystagmus, sedation, ataxia, diplopia Cognitive impairment, gingival hyperplasia, hirsutism

Rash, fetal harm, bleeding tendencies in newborns Narrow therapeutic range (10 to 20 mcg/mL) Can decrease the effect of other drugs such as: Oral contraceptives, warfarin, and glucocorticoids

Inject slowly, use normal saline flush

Withdraw over a period of 6 to 8 weeks to avoid seizures

PHENYTOIN (DILANTIN)

Antiepileptic Drug (AED)

VALPROIC ACID (DEPAKOTE)

Antiepileptic Drug (AED)

Blocks sodium channels to suppress neurons

Suppresses calcium influx

Increases inhibitory influence of gamma-aminobutyric acid (GABA) Uses

Epilepsy, bipolar disorder, migraine headaches Adverse Effects

Nausea, vomiting, indigestion Hepatotoxicity, pancreatitis, fetal harm

Weight gain, rash, hair loss, tremor Blood dyscrasias

VALPROIC ACID (DEPAKOTE)

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MORPHINE

Opioid Analgesic

Activates mu receptors Produces analgesia, euphoria, sedation

Uses Relief of pain Adverse Effects

Respiratory depression, constipation Orthostatic hypotension, urinary retention, miosis Biliary colic, euphoria, sedation, cough suppression

Tolerance and physical dependence Reversed with naloxone (Narcan)

MORPHINE

Opioid Analgesic

NALOXONE (NARCAN)

Opioid Antagonist

Reverses the effects of opioids

Uses Opioid overdose

Reversal of excessive respiratory depression Adverse Effects

Minimal

NALOXONE (NARCAN)

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SUMATRIPTAN (IMITREX)

Serotonin

_1B/1D

-Receptor Agonist (Triptan)

Binds to 5-HT1B/1Dreceptors to cause vasoconstriction

Reduces release of inflammatory peptides Diminishes perivascular inflammation

Uses Migraine headache Adverse Effects

Chest pressure, coronary vasospasm Fetal harm

SUMATRIPTAN (IMITREX)

Serotonin

1B/1D

-Receptor Agonist (Triptan)

CONVENTIONAL ANTIPSYCHOTICS

(NEUROLEPTICS)

Relieve positive symptoms of schizophrenia

Block receptors for dopamine, acetylcholine (ACh), histamine, and norepinephrine (NE)

Uses

Schizophrenia, bipolar disorder, Tourette’s syndrome, and dementia Adverse Effects

Extrapyramidal symptoms (EPS) (acute dystonia, parkinsonism, akathisia, tardive dyskinesia)

Neuroleptic malignant syndrome Anticholinergic effects, orthostatic hypotension

Sedation, neuroendocrine effects, seizures Sexual dysfunction, increased risk of sunburn

Agranulocytosis, dysrhythmias

CONVENTIONAL ANTIPSYCHOTICS

(NEUROLEPTICS)

Chlorpromazine (Thorazine) Thioridazine (Mellaril) Haloperidol (Haldol)

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ATYPICAL ANTIPSYCHOTICS

Relieve positive and negative signs and symptoms of schizophrenia Block receptors for serotonin, dopamine, ACh, histamine, and NE

Clinically superior to conventional antipsychotics Uses

Schizophrenia Adverse Effects

Sedation, orthostatic hypotension, weight gain, dry mouth Blurry vision, urinary retention, constipation, tachycardia

Galactorrhea, gynecomastia, amenorrhea, diabetes Agranulocytosis, seizures

Low risk of extrapyramidal effects

ATYPICAL ANTIPSYCHOTICS

Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify)

SELECTIVE SEROTONIN REUPTAKE

INHIBITORS (SSRIs)

Antidepressants

Inhibit serotonin reuptake (more serotonin is available at the synapse) Uses

Major depression, OCD Panic disorder, PTSD, PMDD

Adverse Effects

Sexual dysfunction, nausea, headache, insomnia Weight gain, serotonin syndrome

Withdrawal syndrome

SELECTIVE SEROTONIN REUPTAKE

INHIBITORS (SSRIs)

Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro)

Antidepressants

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TRICYCLIC ANTIDEPRESSANTS (TCAs)

Antidepressants

Inhibit reuptake of NE and serotonin (more serotonin and NE available at the synapse)

Uses

Depression, bipolar disorder, insomnia, and neuropathic pain Adverse Effects

Orthostatic hypotension, sedation Anticholinergic effects Cardiotoxicity, seizures, hypomania

Many drug interactions

SSRIs preferred for treatment of depression

TRICYCLIC ANTIDEPRESSANTS (TCAs)

Amitriptyline (Elavil)

Clomipramine (Anafranil) Desipramine (Norpramin)

Doxepin (Sinequan)

Antidepressants

MONOAMINE OXIDASE INHIBITORS (MAOIs)

Antidepressants

Increase NE and serotonin by blocking enzyme that inactivates them Uses

Depression Adverse Effects

CNS stimulation, orthostatic hypotension Hypertensive crisis from buildup of dietary tyramine

Many drug interactions

SSRIs preferred for treatment of depression

MONOAMINE OXIDASE INHIBITORS (MAOIs)

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LITHIUM

Mood-Stabilizing Drug

Mechanism unclear, may alter ions and neurotransmitters Uses

Stabilizes mood in patients with bipolar disorder Reduces euphoria, hyperactivity, and other symptoms

Preferred for patients with classic (euphoric) mania Adverse Effects

Accumulates to toxic levels in the presence of a low sodium level Lithium levels must be kept below 1.5 mEq/L

Blood levels drawn 12 hours after evening dose

Signs of toxicity include fine hand tremor, GI upset, thirst, polyuria, and muscle weakness

Chronic use can lead to renal toxicity and hypothyroidism Pregnancy Risk Category D

Drug interactions occur with diuretics, NSAIDs, and anticholinergics

LITHIUM

Mood-Stabilizing Drug

VALPROIC ACID (DEPAKOTE)

Mood-Stabilizing Anticonvulsant

Suppresses mania and stabilizes mood

Uses

Mood stabilizer for patients with bipolar disorder Adverse Effects

GI disturbances, weight gain

Rare thrombocytopenia, pancreatitis, liver failure Target trough level is 50 to 125 mg/mL

VALPROIC ACID (DEPAKOTE)

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LAMOTRIGINE (LAMICTAL)

Newer Mood-Stabilizing Anticonvulsant

Shows some efficacy in treating bipolar disorder

Uses Bipolar disorder Adverse Effects Headache, dizziness, double vision

Life-threatening rashes include Stevens-Johnson syndrome and epidermal necrolysis

LAMOTRIGINE (LAMICTAL)

Newer Mood-Stabilizing Anticonvulsant

BENZODIAZEPINES (BZDs)

Sedative Hypnotic Drugs

Depress central nervous system function

Reduce anxiety, promote sleep

Potentiate the actions of GABA (an inhibitory neurotransmitter) Uses

Anxiety, insomnia, seizure disorder, induction of anesthesia Muscle spasm, panic disorder, and withdrawal from alcohol

Adverse Effects

CNS depression, anterograde amnesia, paradoxic effects Weak respiratory depression if given orally IV administration can cause severe respiratory depression

Abuse and addiction, teratogenic

Do not mix with other CNS depressants or alcohol Reversal agent is flumazenil (Romazicon)

BENZODIAZEPINES (BZDs)

Alprazolam (Xanax) Diazepam (Valium) Flurazepam (Dalmane) Lorazepam (Ativan) Midazolam (Versed) Temazepam (Restoril)

Sedative-Hypnotic Drugs

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ZOLPIDEM (AMBIEN)

Sedative-Hypnotics

BZD-like Drugs

Short-term management of insomnia Adverse Effects

Daytime drowsiness, dizziness

Do not use with alcohol or other CNS depressants

ZOLPIDEM (AMBIEN)

ZALEPLON (SONATA)

Sedative-Hypnotics

BZD-like Drugs

BARBITURATES

CNS Depressants

Insomnia

Suppression of seizures, induction of general anesthesia Adverse Effects

Respiratory depression, decreased blood pressure and heart rate Induction of hepatic drug-metabolizing enzymes (increases the

metabolism of other drugs) May lead to tolerance and dependence Frequently used as vehicles for suicide

Teratogenic

BARBITURATES

Thiopental (Pentothal) Secobarbital (Seconal) Phenobarbital

CNS Depressants

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METHYLPHENIDATE

(RITALIN, METADATE, CONCERTA)

CNS Stimulant for ADHD

Promotes norepinephrine (NE) and dopamine (DA) release Inhibits NE and DA reuptake

Uses

Attention deficit/hyperactivity disorder (ADHD) Narcolepsy

Adverse Effects

Insomnia, reduced appetite, palpitations, hypertension, angina, dysrhythmias, psychosis

Abrupt discontinuation can lead to withdrawal reactions Potential for abuse (Schedule II)

Sudden death

METHYLPHENIDATE

(RITALIN, METADATE, CONCERTA)

CNS Stimulant for ADHD

ATOMOXETINE (STRATTERA)

Nonstimulant Drug for ADHD

Selective inhibitor of NE reuptake Causes NE to accumulate at synapses

Uses

ADHD in children and adults Adverse Effects

GI reactions, reduced appetite, dizziness, and somnolence Urinary retention, mood swings, insomnia, sexual dysfunction

ATOMOXETINE (STRATTERA)

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ADDERALL

CNS Stimulant Used for ADHD

Combination Amphetamine

Uses ADHD Adverse Effects Insomnia, growth suppression Headache, abdominal pain, lethargy

Abuse potential (Schedule II) Sudden death Drug holidays recommended

ADDERALL

CNS Stimulant Used for ADHD

Combination Amphetamine

DISULFIRAM (ANTABUSE)

Aversion Therapy for Alcoholism

Disrupts alcohol metabolism by blocking enzyme Aldehyde accumulates and produces unpleasant effects

Uses Alcohol abuse Adverse Effects

Nausea, vomiting, flushing, palpitations, headache Sweating, blurry vision, hypotension, chest pain, shock

will occur with 7 mL of alcohol ingestion

DISULFIRAM (ANTABUSE)

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FUROSEMIDE (LASIX)

Loop Diuretic

Blocks reabsorption of sodium and chloride in the descending limb of the loop of Henle to promote urination

Produces profound diuresis Uses

Rapid mobilization of fluid

Pulmonary edema resulting from heart failure or renal or liver disease Especially useful in patients with renal insufficiency

Adverse Effects

Hypokalemia, hyponatremia, hypochloremia, dehydration, hypotension, and ototoxicity

May cause dysrhythmias when used with digoxin (decreases potassium)

FUROSEMIDE (LASIX)

Loop Diuretic

HYDROCHLOROTHIAZIDE (HCTZ)

Thiazide Diuretic

Blocks reabsorption of sodium and chloride in the early segment of the distal convoluting tubule to promote urination

Uses

Treatment of hypertension

Mobilization of edema with mild heart failure, hepatic or renal disease Adverse Effects

Hyponatremia, hypochloremia, dehydration Hypokalemia and hypotension

HYDROCHLOROTHIAZIDE (HCTZ)

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SPIRONOLACTONE (ALDACTONE)

Potassium-Sparing Diuretic

Blocks the actions of aldosterone in the distal nephron Causes the retention of potassium and increased excretion of sodium

Uses

Hypertension and edema Heart failure Primary hyperaldosteronism

Adverse Effects Endocrine effects such as:

Gynecomastia, menstrual irregularities, impotence, and hirsutism Hyperkalemia

SPIRONOLACTONE (ALDACTONE)

Potassium-Sparing Diuretic

ENALAPRIL (VASOTEC)

Angiotensin-Converting Enzyme (ACE) Inhibitor

Inhibits ACE, reducing levels of angiotensin II

Dilates arterioles and veins to reduce BP Reduces blood volume

Uses

Hypertension, heart failure, MI, diabetic nephropathy Prevention of MI, stroke, and death

Adverse Effects Hypotension, cough, hyperkalemia Renal failure in patients with renal artery stenosis

Fetal injury Angioedema

ENALAPRIL (VASOTEC)

Benazepril (Lotensin) Fosinopril (Monopril) Lisinopril (Prinivil and Zestril)

Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)

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LOSARTAN (COZAAR)

Angiotensin II-Receptor Blocker (ARB)

Blocks the actions of angiotensin II

Dilates arterioles and veins to reduce BP Reduces blood volume

Uses

Hypertension, heart failure, MI, and diabetic nephropathy Prevention of MI, stroke, and death

Adverse Effects

Renal failure in patients with renal artery stenosis Hypotension

Angioedema Fetal injury

Does not cause cough or hyperkalemia

LOSARTAN (COZAAR)

Candesartan (Atacand) Eprosartan (Teveten) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan)

Angiotensin II-Receptor Blockers (ARBs)

VERAPAMIL (CALAN)

DILTIAZEM (CARDIZEM)

Calcium Channel Blockers (CCBs)

Nondihydropyridines

Block calcium channels in the heart and blood vessels Reduce BP by blocking calcium channels in the arterioles

Increase coronary perfusion

Block SA and AV nodes to reduce heart rate and contractility Decrease force of contraction

Uses

Angina, hypertension, cardiac dysrhythmias Adverse Effects

Constipation, dizziness, facial flushing, edema, hypotension Bradycardia, AV block, decreased cardiac contractility

VERAPAMIL (CALAN)

DILTIAZEM (CARDIZEM)

Calcium Channel Blockers (CCBs)

Nondihydropyridines

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AMLODIPINE (NORVASC)

Calcium Channel Blocker

Dihydropyridine

Blocks calcium channels in the blood vessels Vasodilation in peripheral arterioles lowers blood pressure

Uses Hypertension

Angina Adverse Effects

Peripheral edema, flushing, dizziness, headache Does not slow heart rate like nondihydropyridines

AMLODIPINE (NORVASC)

Calcium Channel Blocker

Dihydropyridine

DIGOXIN (LANOXIN)

Cardiac Glycoside Positive Inotropic Agent

Drug for Heart Failure

Increases the force of ventricular contraction Inhibits Na_{, K}_{-ATPase to increase Ca}_{inside myocytes}

Competes with Kfor binding to Na, K-ATPase ↓K → ↑ Na_{, K}_{-ATPase inhibition}_{→ digoxin toxicity} Changes electrical activity of the heart and slows heart rate

Uses

Heart failure and dysrhythmias Adverse Effects Anorexia, nausea and vomiting, fatigue Visual disturbances (blurry vision, yellow tinge, halos)

Dysrhythmias

Digoxin toxicity (therapeutic level 0.5 to 0.8 ng/mL) Hold if HR 60 BPM or K_{is low}

Inject slowly over 5 minutes

DIGOXIN (LANOXIN)

Cardiac Glycoside

Positive Inotropic Agent

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AMIODARONE (CORDARONE)

Antidysrhythmic

Class III Potassium Channel Blocker

Delays repolarization

Reduces automaticity in the SA node, reduces contractility Decreases conduction velocity in the AV node, ventricles, and

His-Purkinje system Uses

Recurrent ventricular fibrillation Unstable ventricular tachycardia

Adverse Effects Widening of the QRS complex Prolongation of the PR and QT intervals

Pulmonary toxicities, sinus bradycardia, AV block, hypotension Corneal microdeposits, optic neuropathy

Hepatitis, thyroid dysfunction Toxicities in pregnancy

Grapefruit juice increases levels to toxicity

AMIODARONE (CORDARONE)

Antidysrhythmic

Class III Potassium Channel Blocker

VERAPAMIL (CALAN)

DILTIAZEM (CARDIZEM)

Antidysrhythmics

Class IV Calcium Channel Blockers

Block calcium channels in the heart

Slow SA node automaticity, delay AV nodal conduction Reduce myocardial contractility

Uses

Atrial fibrillation or atrial flutter Supraventricular tachycardia

Adverse Effects

Bradycardia, AV block, and heart failure Hypotension, peripheral edema, and constipation

Can elevate digoxin levels Grapefruit juice increases levels to toxicity

VERAPAMIL (CALAN)

DILTIAZEM (CARDIZEM)

Antidysrhythmics

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PROCAINAMIDE (PRONESTYL)

Antidysrhythmic

Class IA Sodium Channel Blocker

Blocks cardiac sodium channels

Slows conduction in the atria, ventricles, and His-Purkinje system Delays depolarization

Uses

Atrial and ventricular dysrhythmias Adverse Effects

Systemic lupus erythematous–like syndrome Blood dyscrasias

QRS widening and prolongation

PROCAINAMIDE (PRONESTYL)

Antidysrhythmic

Class IA Sodium Channel Blocker

LIDOCAINE (XYLOCAINE)

Antidysrhythmic

Class IB Sodium Channel Blocker

Blocks cardiac sodium channels

Slows conduction in the atria, ventricles, and His-Purkinje system Reduces automaticity in the ventricles and His-Purkinje system

Accelerates repolarization Uses

Short-term therapy for ventricular dysrhythmias Adverse Effects

No significant impact on the ECG Drowsiness, confusion, and paresthesias

Toxic doses may produce convulsions and respiratory arrest

LIDOCAINE (XYLOCAINE)

Antidysrhythmic

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PROPRANOLOL (INDERAL)

Antidysrhythmic

Class II Beta Blocker

Beta-adrenergic antagonist Blocks both beta1and beta2receptors

Decreases automaticity of the SA node Decreases velocity of conduction through the AV node

Decreases myocardial contractility Uses

Sinus tachycardia, severe recurrent ventricular tachycardia Paroxysmal atrial tachycardia, hypertension

Adverse Effects Prolongs PR interval on the ECG

Bradycardia, heart failure, AV block, and sinus arrest Bronchospasm in patients with asthma

PROPRANOLOL (INDERAL)

Antidysrhythmic

Class II Beta Blocker

ATORVASTATIN (LIPITOR)

Lipid-Lowering Drug

HMG-CoA Reductase Inhibitor (Statin)

Inhibits the enzyme that synthesizes cholesterol Increases the number of LDL receptors to remove LDL

Slows progression of CHD, stabilizes plaque Uses

Hypercholesterolemia Primary prevention of CHD

Adverse Effects

Hepatotoxicity, increases ALT and AST

Myopathy, increases CK levels, rhabdomyolysis, dark urine, renal failure Pregnancy Risk Category X

Headache, rash, GI complaints

Cyclosporine, macrolide antibiotics, azole antifungals, and HIV protease inhibitors raise some statins to toxic levels

ATORVASTATIN (LIPITOR)

FLUVASTATIN (LESCOL)

LOVASTATIN (MEVACOR)

PRAVASTATIN (PRAVACHOL)

SIMVASTATIN (ZOCOR)

ROSUVASTATIN (CRESTOR)

Lipid-Lowering Drugs

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NICOTINIC ACID (NIACIN)

Lipid-Lowering Agent

Reduces LDL and triglycerides

Increases HDL Uses Dyslipidemia Adverse Effects Hepatotoxicity Flushing, itching

Gastric upset, nausea, vomiting, diarrhea May raise blood sugar in patients with diabetes

May increase incidence of gout

NICOTINIC ACID (NIACIN)

Lipid-Lowering Agent

CHOLESTYRAMINE (QUESTRAN)

Bile-Acid Sequestrant

Forms insoluble complex with bile acids

Increases LDL receptors Safest of all lipid-lowering drugs

Uses Hypercholesterolemia Often used in combination with statin

Adverse Effects Constipation, bloating, indigestion Reduces uptake of fat-soluble vitamins Interferes with absorption of other drugs

CHOLESTYRAMINE (QUESTRAN)

COLESEVELAM (WELCHOL)

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GEMFIBROZIL (LOPID)

Fibric Acid Derivative (Fibrate)

Decreases triglycerides by lowering VLDL

Raises HDL levels Uses Hypertriglyceridemia

Adverse Effects Myopathy, liver injury Rash, nausea, abdominal pain, diarrhea

Gallstone formation

Increases warfarin levels, leading to hemorrhage

GEMFIBROZIL (LOPID)

FENOFIBRATE (TRICOR)

Fibric Acid Derivatives (Fibrates)

EZETIMIBE (ZETIA)

Cholesterol-Lowering Drug

Blocks cholesterol absorption in the small intestine

Uses Hypercholesterolemia Used in combination with statins

Adverse Effects

May increase risk of liver damage when used with statin May increase risk of gallstone formation

EZETIMIBE (ZETIA)

(27)

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NITROGLYCERINE

Organic Nitrate

Dilates veins, decreases venous return to the heart Decreases preload

Decreases cardiac oxygen demand Uses

Angina, myocardial infarction Adverse Effects Headache, orthostatic hypotension

Reflex tachycardia

Use with sildenafil (Viagra), other drugs for erectile dysfunction may lead to severe hypotension

NITROGLYCERINE

Organic Nitrate

CLOPIDOGREL (PLAVIX)

Adenosine Diphosphate–Receptor Antagonist

ADP Receptor Blocker

Antiplatelet Drug

Blocks enzyme so that platelets are unable to aggregate Uses

Prevention of stroke and MI Adverse Effects

Hemorrhage

CLOPIDOGREL (PLAVIX)

Adenosine Diphosphate–Receptor Antagonist

ADP Receptor Blocker

(28)

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EPTIFIBATIDE (INTEGRILIN)

Glycoprotein llb/llla–Receptor Antagonists

Antiplatelet Drug—”Super Aspirin”

Interferes with the final step in platelet aggregation Uses

Acute coronary syndrome Used during angioplasty

Adverse Effects

Intercranial hemorrhage, gastrointestinal bleeding Hematuria, gingival bleeding

Thrombocytopenia Anaphylaxis

EPTIFIBATIDE (INTEGRILIN)

Glycoprotein llb/llla–Receptor Antagonists

Antiplatelet Drug—”Super Aspirin”

ALTEPLASE (tPA)

Thrombolytic Drug

Converts plasminogen to plasmin

Plasmin is an enzyme that digests the fibrin matrix of clots Uses

Acute myocardial infarction, pulmonary embolism, and ischemic stroke Adverse Effects

Bleeding Intracranial hemorrhage

ALTEPLASE (tPA)

(29)

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HEPARIN

Parenteral Anticoagulant

Suppresses the formation of fibrin in veins Inactivates clotting factors thrombin and Xa

Anticoagulant effect develops quickly

Uses

Prevents venous thrombosis

Used for pulmonary embolism, evolving stroke, DVT Open heart surgery, MI, renal dialysis

Monitoring

Activated partial thromboplastin time (aPTT) Normal aPTT 40 seconds; therapeutic level 60 to 80 seconds

Adverse Effects

Bleeding—antidote is protamine sulfate Heparin-induced thrombocytopenia (HIT) (Decreased platelet count 100,000 leads to thrombosis)

May be used during pregnancy

HEPARIN

Parenteral Anticoagulant

WARFARIN (COUMADIN)

Oral Anticoagulant

Suppresses coagulation by antagonizing vitamin K Blocks synthesis of factors VII, IX, X, and prothrombin

Effect takes a few days

Uses

Long-term prophylaxis of venous thrombosis Used in patients with mechanical heart valves

Used in patients with atrial fibrillation

Monitoring

Prothrombin time (PT)—reported as INR Goal INR for atrial fibrillation is 2–3 Goal INR for mechanical valves is 3–4.5

Adverse Effects

Hemorrhage—antidote is vitamin K

WARFARIN (COUMADIN)

(30)

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FERROUS SULFATE

Oral Iron Preparation

Uses

Iron deficiency anemia (microcytic hypochromic anemia) Adverse Effects

Nausea, heartburn, bloating, constipation, diarrhea Liquid iron preparation stains teeth Toxic to children (lethal dose is 2 to 10 grams)

FERROUS SULFATE

Oral Iron Preparation

CYANOCOBALAMIN (VITAMIN B

12

)

Essential for synthesis of DNA

Catalyzes conversion of folic acid to its active form Uses

B12deficiency, pernicious anemia

Macrocytic normochromic anemia (megaloblastic anemia) Adverse Effects

Hypokalemia

(31)

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FOLIC ACID (FOLATE)

Essential for synthesis of DNA Uses

Treatment of folic acid deficiency (megaloblastic anemia) Used prophylactically to prevent neural tube defects (NTDs)

Adverse Effects

Folic acid does not correct neurologic consequences Will correct anemia, but may mask B12deficiency

Always give folic acid with B12

FOLIC ACID (FOLATE)

OPRELVEKIN (INTERLEUKIN-11)

Thrombopoietic Growth Factor

Stimulates production of platelets (thrombocytes)

Uses

Used in patients undergoing chemotherapy to increase platelets Adverse Effects

Retention of sodium and water by kidney Peripheral edema

Anemia, dyspnea, tachycardia

OPRELVEKIN (INTERLEUKIN-11)

(32)

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EPOETIN ALFA (ERYTHROPOIETIN)

Hematopoietic Growth Factor

Stimulates production of red blood cells

Uses

Anemia of chronic renal failure

Anemia due to AIDS treatment with AZT (zidovudine) Anemia caused by chemotherapy

Adverse Effects Hypertension

Increase in cardiovascular events Red cell aplasia

EPOETIN ALFA (ERYTHROPOIETIN)

Hematopoietic Growth Factor

FILGRASTIM (NEUPOGEN)

Granulocyte Colony Stimulating Factor (G-CSF)

Acts on bone marrow to increase production of neutrophils

Uses

Used in patients undergoing chemotherapy Decreases risk of infection

Adverse Effects Bone pain, leukocytosis

Elevates uric acid levels, LDH, and alkaline phosphatase Splenomegaly

FILGRASTIM (NEUPOGEN)

(33)

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GLIPIZIDE (GLUCOTROL)

Oral Hypoglycemic Agent

Sulfonylurea

Stimulates insulin release from the pancreas Uses Type 2 diabetes Adverse Effects Hypoglycemia Fetal harm

GLIPIZIDE (GLUCOTROL)

GLYBURIDE (MICRONASE)

GLIMEPIRIDE (AMARYL)

Oral Hypoglycemic Agents

Sulfonylureas

METFORMIN (GLUCOPHAGE)

Oral Hypoglycemic Agent

Biguanide

Decreases blood sugar by decreasing production of glucose in the liver Enhances glucose uptake and utilization in muscle

Uses Type 2 diabetes Adverse Effects

Decreased appetite, nausea, diarrhea, and weight loss Lactic acidosis

Avoid in patients with renal or liver disease Avoid in patients with ETOH abuse, infection, or CHF Discontinue 48 hours prior to test with contrast media to avoid

lactic acidosis

METFORMIN (GLUCOPHAGE)

Oral Hypoglycemic Agent

Biguanide

(34)

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ROSIGLITAZONE (AVANDIA)

Thiazolidinedione (TZD)

“Glitazone”

Insulin Sensitizer

Increases insulin sensitivity

Fluid retention—caution in patients with CHF Hepatotoxicity—monitor ALT

ROSIGLITAZONE (AVANDIA)

PIOGLITAZONE (ACTOS)

Thiazolidinediones (TZDs)

“Glitazones”

Insulin Sensitizers

MIGLITOL (GLYSET)

ACARBOSE (PRECOSE)

Alpha-Glucosidase Inhibitors

Hypoglycemic Agent

Delay absorption of carbohydrates Lower postprandial blood glucose levels

Flatulence, cramps, abdominal distention, diarrhea Hypoglycemia, liver dysfunction

MIGLITOL (GLYSET)

ACARBOSE (PRECOSE)

Alpha-Glucosidase Inhibitors

Hypoglycemic Agents

(35)

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REPAGLINIDE (PRANDIN)

NATEGLINIDE (STARLIX)

Meglitinides

Hypoglycemic Agents

Stimulate pancreatic insulin release

Hypoglycemia

Administer 30 minutes before meal

REPAGLINIDE (PRANDIN)

NATEGLINIDE (STARLIX)

Meglitinides

Hypoglycemic Agents

GLUCAGON

Hormone that increases plasma levels of glucose Opposite effect of insulin

Uses

Treats hypoglycemia from insulin overdose Used only if IV glucose is not available

(36)

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LEVOTHYROXINE (SYNTHROID, LEVOXYL)

Thyroid Replacement Hormone

Synthetic Preparation of T

4

Converted to T3in the body

Thyroid hormone replacement Uses

Hypothyroidism Adverse Effects

Thyrotoxicosis if dosage is excessive Tachycardia, angina, nervousness, insomnia

Hyperthermia, sweating, and tremor Increases warfarin levels Takes about 1 month to reach plateau

LEVOTHYROXINE (SYNTHROID, LEVOXYL)

Thyroid Replacement Hormone

Synthetic Preparation of T

₄

PROPYLTHIOURACIL (PTU)

Antithyroid Drug

Inhibits thyroid hormone synthesis

Uses

Hyperthyroidism, Graves’ disease Thyrotoxic crisis

Adverse Effects

Agranulocytosis, hypothyroidism, rash Fetal harm

PROPYLTHIOURACIL (PTU)

(37)

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GLUCOCORTICOIDS

Suppress immune responses and inflammation Inhibit prostaglandins, leukotrienes, and histamine

Suppress phagocytes and lymphocytes Uses

Rheumatoid arthritis, SLE, inflammatory bowel disease Bursitis, osteoarthritis, anaphylaxis, asthma

Skin disorders, prevention of respiratory distress syndrome (RDS) in preterm infants

Replacement therapy for patients with Addison’s disease Adverse Effects

Adrenal insufficiency resulting from suppression of HPA axis Glucose intolerance (increases blood sugar), osteoporosis, infection

Growth retardation, mood changes, cataracts, glaucoma Peptic ulcer disease, iatrogenic Cushing’s syndrome

GLUCOCORTICOIDS

SILDENAFIL (VIAGRA)

Erectile Dysfunction Drug

Enhances the normal erectile response to sexual stimuli by inhibiting PDE-5

Uses Erectile dysfunction

Adverse Effects

Hypotension, priapism, headache, and flushing Visual changes

Use with nitrates and alpha blockers leads to hypotension

SILDENAFIL (VIAGRA)

TADALAFIL (CIALIS)

VARDENAFIL (LEVITRA)

(38)

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PRAZOSIN (MINIPRESS)

Alpha-Adrenergic Antagonist

Alpha Blocker

Blocks alpha1receptors

Dilates arteries and veins

Relaxes smooth muscle in the bladder neck and prostatic capsule Uses

Benign prostatic hypertrophy Hypertension Adverse Effects

Orthostatic hypotension, reflex tachycardia Inhibition of ejaculation

Nasal congestion

Use with erectile dysfunction drugs may lead to hypotension

PRAZOSIN (MINIPRESS)

Alpha-Adrenergic Antagonist

Alpha Blocker

LIVE VIRUS VACCINES

Live virus vaccines are contraindicated in pregnancy Give with caution in immunocompromised patients

LIVE VIRUS VACCINES

Varicella (Varivax)

Oral Polio Vaccine (OPV) not used in the United States Measles, Mumps, and Rubella Virus Vaccine (MMR)

(39)

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CYCLOSPORINE (SANDIMMUNE)

Immunosuppressant Drug

Suppresses production of inflammatory cells

Decreases B cells and cytotoxic T cells Uses

Organ transplant Adverse Effects

Nephrotoxicity, infection, hepatotoxicity, lymphomas Hypertension, anaphylaxis, fetal harm

CYCLOSPORINE (SANDIMMUNE)

Immunosuppressant Drug

METHOTREXATE (RHEUMATREX, TREXALL)

Cytotoxic Drug

Immunosuppressant

Disease-Modifying Antirheumatic Drug (DMARD)

Blocks conversion of folic acid to its active form

Reduces joint destruction, retards disease progression Takes 3 to 5 months to see effect

Uses

Rheumatoid arthritis, non-Hodgkin’s lymphoma Lymphocytic leukemia, psoriasis

Adverse Effects

Bone marrow suppression, hepatic fibrosis GI ulceration, pneumonitis, and fetal harm

METHOTREXATE (RHEUMATREX, TREXALL)

Cytotoxic Drug

Immunosuppressant

(40)

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DIPHENHYDRAMINE (BENADRYL)

First-Generation H

₁

Antagonist

Antihistamine

Blocks H1receptors

Blocks some muscarinic receptors Reduces actions of histamine

Decreases flushing, itching, and secretion of mucus Uses

Allergic rhinitis, urticaria, motion sickness, insomnia Cold symptoms, mild transfusion reactions, allergic reactions

Adverse Effects

Sedation, confusion, nausea, and dry throat

DIPHENHYDRAMINE (BENADRYL)

First-Generation H

1

Antagonist

Antihistamine

LORATADINE (CLARITIN)

Second-Generation Nonsedating H

₁

Antagonist (Antihistamine)

Blocks H1receptors

Reduces actions of histamine

Decreases flushing, itching, secretion of mucus Does not cross blood-brain barrier to cause sedation

Uses

Allergic rhinitis, urticaria, and mild transfusion reactions Adverse Effects

Decrease dose if hepatic or renal impairment occurs Cetirizine (Zyrtec) may cause mild sedation in some patients

LORATADINE (CLARITIN)

DESLORATADINE (CLARINEX)

FEXOFENADINE (ALLEGRA)

CETIRIZINE (ZYRTEC)

Second-Generation Nonsedating H

₁

Antagonists (Antihistamines)

(41)

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ASPIRIN

Antiplatelet Drug

Cyclooxygenase (COX) Inhibitor

First-Generation NSAID

Suppresses platelet aggregation by inhibiting COX-1 and COX-2 Decreases prostaglandin synthesis

Reduces inflammation, pain, and fever Uses

Pain, fever, inflammation Prevention of thrombus in arteries

Prevents MI and stroke Adverse Effects

Bleeding, gastric ulceration, renal impairment Not used in children because of Reye’s syndrome

Fetal harm, salicylism

Hypersensitivity in patients with allergies

ASPIRIN

Antiplatelet Drug

Cyclooxygenase (COX) Inhibitor

First-Generation NSAID

IBUPROFEN (ADVIL, MOTRIN)

First-Generation NSAID

Inhibits cyclooxygenase (COX)-1 and COX-2

Inhibits prostaglandin synthesis

Has antiinflammatory, analgesic, and antipyretic actions Uses

Dysmenorrhea, arthritis, pain, and fever Adverse Effects

Bleeding, gastric ulceration, renal impairment Cross-hypersensitivity with aspirin May precipitate Reye’s syndrome, fetal harm

IBUPROFEN (ADVIL, MOTRIN)

(42)

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CELECOXIB (CELEBREX)

Second-Generation NSAID

COX-2 Inhibitor

Selective inhibition of COX-2, decreases prostaglandin synthesis (pain and inflammation reduced)

Spares COX-1 inhibition Minimal gastric, renal, and platelet effect

Uses

Osteoarthritis, rheumatoid arthritis, dysmenorrhea Acute pain

Adverse Effects Dyspepsia, mild renal impairment Not used in patients with sulfonamide allergy

Premature closure of ductus arteriosus

CELECOXIB (CELEBREX)

Second-Generation NSAID

COX-2 Inhibitor

ACETAMINOPHEN (TYLENOL)

Analgesic

Antipyretic

Decreases prostaglandin synthesis in the CNS Devoid of antiinflammatory properties

Uses Pain and fever Preferred in children

No GI injury, no effect on platelets or kidneys Adverse Effects

Toxic metabolite builds up in ETOH abusers Hepatic necrosis can occur

Acetylcysteine (Mucomyst) given for overdose

ACETAMINOPHEN (TYLENOL)

Analgesic

Antipyretic

(43)

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FLUTICASONE PROPIONATE (FLOVENT)

Inhaled Corticosteroid (ICS)

Suppresses inflammation

Decreases leukotrienes, histamine, and prostaglandins Decreases eosinophils and leukocytes Reduces edema of airway and mucous production

Reduces bronchial hyperactivity

Increases number and responsiveness of beta2receptors

Uses Asthma Adverse Effects

Oropharyngeal candidiasis—rinse mouth after use Minimal adrenal suppression and bone loss Slows growth but does not reduce adult height Slight increased risk of cataracts and glaucoma

FLUTICASONE PROPIONATE (FLOVENT)

Inhaled Corticosteroid (ICS)

SALMETEROL (SEREVENT)

Long-Acting Inhaled Beta

₂

-Adrenergic Agonist

Activates beta2receptors in the lung

Promotes bronchodilation Suppresses histamine release in the lung

Increases ciliary motility Uses

Asthma Adverse Effects

Effect is delayed by 20 to 30 minutes Not to be used as a rescue inhaler in an emergency

Tachycardia, angina, tremor, and leg cramps

SALMETEROL (SEREVENT)

(44)

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MONTELUKAST (SINGULAIR)

Leukotriene Modifier

Blocks leukotriene receptors

Decreases inflammation, bronchoconstriction, and edema Decreases mucous secretion

Decreases eosinophils and other inflammatory cells Reduces dosage of inhaled corticosteroid (ICS)

Uses

Asthma and allergic rhinitis Adverse Effects GI upset Effect is delayed

MONTELUKAST (SINGULAIR)

Leukotriene Modifier

THEOPHYLLINE

Methylxanthine

Bronchodilator

Produces bronchodilation by relaxing bronchi Uses

Asthma (beta2agonists and corticosteroids preferred)

Adverse Effects

Narrow therapeutic range (5 to 10 mcg/mL) Dysrhythmias, ventricular fibrillation Convulsions, cardiorespiratory collapse, and death

THEOPHYLLINE

Methylxanthine

Bronchodilator

(45)

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ALBUTEROL (PROVENTIL, VENTOLIN, ACCUNEB)

Beta

₂

-Adrenergic Agonist

Bronchodilator

Stimulates beta2receptors in the lung

Bronchodilation

Rapid onset of action for rescue breathing Uses

Asthma Adverse Effects

Hyperglycemia, tachycardia, tremor

ALBUTEROL (PROVENTIL, VENTOLIN, ACCUNEB)

Beta

2

-Adrenergic Agonist

Bronchodilator

RANITIDINE (ZANTAC)

Histamine

₂

-Receptor Antagonist

Blocks H2receptors on parietal cells of the stomach

Reduces volume of gastric juice and hydrogen ion content Uses

Gastric and duodenal ulcers

Gastroesophageal reflux disease (GERD), dyspepsia Treatment of Zollinger-Ellison syndrome

Adverse Effects

Significant side effects are uncommon

RANITIDINE (ZANTAC)

CIMETIDINE (TAGAMET)

FAMOTIDINE (PEPCID)

NIZATIDINE (AXID)

(46)

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OMEPRAZOLE (PRILOSEC)

Proton Pump Inhibitor (PPI)

Inhibits the enzyme that generates acid production

Uses

Duodenal and gastric ulcers, GERD, dyspepsia Zollinger-Ellison syndrome

Adverse Effects

Headache, diarrhea, nausea, and vomiting

OMEPRAZOLE (PRILOSEC)

LANSOPRAZOLE (PREVACID)

RABEPRAZOLE (ACIPHEX)

PANTOPRAZOLE (PROTONIX)

ESOMEPRAZOLE (NEXIUM)

Proton Pump Inhibitors (PPIs)

SUCRALFATE (CARAFATE)

Antiulcer drug

Creates a protective barrier against acid and pepsin Sticky gel adheres to ulcer crater

Uses

Duodenal and gastric ulcers Adverse Effects

May impede the absorption of some drugs Separate at least 2 hours from other drugs

SUCRALFATE (CARAFATE)

(47)

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METOCLOPRAMIDE (REGLAN)

Prokinetic Drug

Reduces emesis by blocking receptors in the chemoreceptor trigger zone (CTZ)

Increases upper GI motility by enhancing the actions of ACh Uses

Suppresses nausea caused by chemotherapy Suppresses postoperative emesis and GERD

Adverse Effects Sedation and diarrhea

Extrapyramidal reactions, especially in children

METOCLOPRAMIDE (REGLAN)

Prokinetic Drug

SULFASALAZINE (AZULFIDINE)

Aminosalicylate

Reduces inflammation Uses

Inflammatory bowel disease Crohn’s disease and ulcerative colitis

Adverse Effects Nausea, fever, rash, and arthralgias

Agranulocytosis, hemolytic anemia, and macrocytic anemia

SULFASALAZINE (AZULFIDINE)

(48)

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ONDANSETRON (ZOFRAN)

Antiemetic Drug

Serotonin-Receptor Antagonist

Suppresses emesis by blocking 5-HT3receptors in the chemoreceptor

trigger zone (CTZ) Uses

Decreases nausea and vomiting due to:

Chemotherapy, radiation therapy, and anesthesia (postoperatively) Adverse Effects

Headache, nausea, and dizziness

ONDANSETRON (ZOFRAN)

Antiemetic Drug

Serotonin-Receptor Antagonist

PROCHLORPERAZINE (COMPAZINE)

Antiemetic Drug

Dopamine Antagonist

Suppresses emesis by blocking dopamine2receptors in the CTZ

Uses Nausea and vomiting

Used after surgery, cancer chemotherapy, or other conditions Adverse Effects

Extrapyramidal reactions, anticholinergic effects Hypotension and sedation

PROCHLORPERAZINE (COMPAZINE)

PROMETHAZINE (PHENERGAN)

Antiemetic Drugs

Dopamine Antagonists

(49)

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HYDROXYZINE (VISTARIL, ATARAX)

Antiemetic Drug

Anticholinergic-Antihistamine

Blocks histaminergic and cholinergic receptors

Uses Nausea Adverse Effects

Sedation, blurry vision, urinary retention, dry mouth

HYDROXYZINE (VISTARIL, ATARAX)

Antiemetic Drug

Anticholinergic-Antihistamine

PENICILLIN G (BENZYLPENICILLIN)

Narrow-Spectrum Penicillin

Weakens the bacterial cell wall

Uses

Treats Streptococcus, Neisseria, anaerobes, and others Drug of choice for syphilis

Adverse Effects

Allergic reaction, pain at site of injection Neurotoxicities

PENICILLIN G (BENZYLPENICILLIN)

(50)

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NAFCILLIN (UNIPEN)

Penicillinase-Resistant Penicillin

(Antistaphylococcal Penicillin)

Weakens the cell wall Uses

Treats infections caused by Staphylococcus aureus Adverse Effects

Allergic reaction, GI effects Thrombophlebitis, hypokalemia

NAFCILLIN (UNIPEN)

Penicillinase-Resistant Penicillin

(Antistaphylococcal Penicillin)

AMOXICILLIN (AMOXIL)

Broad-Spectrum Penicillin (Aminopenicillin)

Weakens the bacterial cell wall

Uses

Treats infections caused by Haemophilus influenzae, Escherichia coli,

Proteus mirabilis, enterococci Neisseria gonorrhoeae

Adverse Effects Diarrhea