Medications of the Digestive system

Antacids
Aluminum hydroxide, magnesium hydroxide (Mylanta, Maalox)
Calcium carbonate (Tums, Rolaids, Chooz)
Bismuth subsalicylate (Pepto-Bismol)
Sodium bicarbonate (Alka-Seltzer)

Mechanism of Action
o The antacids act by neutralizing the acid in the stomach and by inhibiting
pepsin, which is a proteolytic enzyme. Each of these cationic salts has a
characteristic pharmacological property that determines its clinical use.
The antacids reduce the acid reaching the duodenum by neutralizing the acid present in the
stomach. The main therapeutic objectives are:
 Alleviating pain
 Relieving pylorospasms
 Avoid digestion and corrosion by acid chyme
The salts' mechanism of neutralization of acid varies, and each salt has a different mechanism
with the ultimate goal of acid neutralization.
Aluminum Hydroxide
The formulation of aluminum hydrochloride and water results in the neutralization of the acid in
the stomach. It is also known to inhibit pepsin activity.[7] Aluminum hydroxide is complexed
with a sulfated polysaccharide sucrose octasulfate to form sucralfate. This complex does not
have a significant buffering action against the acid or has no effect on the pepsin secretion, and
does not alter the gastric acid production in any way.[8][9] Nevertheless, it is known to heal
chronic ulcers and prevent acute mucosal damage induced chemically by reducing access to
pepsin and acid. Sucralfate, like its aluminum hydroxide component, is known to stimulate
angiogenesis and granulation tissue formation.[8]
Aluminum hydroxide is also useful in hyperphosphatemia due to its ability to bind phosphate in
the gastrointestinal (GI) tract and subsequently prevent the absorption of phosphate.[10]
Calcium Salts
Calcium salts neutralize gastric acidity, resulting in increased gastric and duodenal bulb pH; they
also inhibit pepsin's proteolytic activity if the pH is greater than 4 and increase lower esophageal
sphincter tone. The calcium released from calcium carbonate is known to increase peristalsis in
the esophagus, pushing the acid into the stomach and providing relief from heartburn symptoms.
The calcium salts also form combined insoluble compounds with dietary phosphate and prevent
the absorption of the latter.[11]
The acid-neutralizing mechanism of the antacids is well understood, as mentioned above. In
addition to this, other mechanisms add to the ulcer healing properties of this class of drugs. The
exact mechanism is still unclear, but it is believed to be a combination of[12][7]:
 Ability to promote angiogenesis
 Bind to bile acids
 Inhibit peptic activity
 Suppress Helicobacter pylori growth

Therapeutic action
o Antacids are medicines that counteract (neutralise) the acid in your stomach to
relieve indigestion and heartburn.
Side effects
Adverse Effects
Adverse effects are prominent in the infant and the elderly populations. The chronic use of
antacids in this population is not a recommendation due to safety concerns.
Aluminum Hydroxide
Aluminum use is associated with an increased risk of toxicity in individuals with renal failure
and infants. It presents as[17][18][19][20]:
 Osteopenia
 Microcytic anemia
 Neurotoxicity
 Osteomalacia
 Constipation 
 Fecal impaction
 Nausea
 Vomiting
 Abdominal cramps
 Hypomagnesemia
 Hypophosphatemia
Calcium Carbonate
The adverse reactions often seen with this  group of antacids are[20][21]:
 Abdominal pain
 Anorexia
 Constipation
 Acid rebound
 Nausea
 Vomiting
 Flatulence
 Xerostomia
 Headache
 Hypercalcemia
 Hypophosphatemia
 Milk-alkali syndrome
Antacids can exhibit clinically significant interactions with other medication a patient may be
taking.[22] Some examples include:
 Using antacids concomitantly with acidic drugs (e.g., digoxin, chlorpromazine
isoniazid) can result in impaired absorption of these acidic drugs, reducing the blood
concentrations of the drugs and impairing their therapeutic effects.
 Concurrent antacid use with some drugs (e.g., pseudoephedrine, levodopa) can result
in increased absorption of the drugs, leading to potential toxicity or adverse events from
increased serum concentration of these drugs.
 Antacids containing magnesium trisilicate and magnesium hydroxide can bind to drugs
like tetracycline and fluoroquinolone antibiotics, impeding their absorption and
therapeutic effects.
 Sodium bicarbonate significantly affects urine acidity, which can alter the renal
elimination of some drugs by the kidney; sodium bicarbonate inhibits the excretion of
basic drugs such as amphetamines and quinidine while increasing the excretion of acidic
drugs like aspirin.
Proton Pump Inhibitors
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Esomeprazole (Nexium)
Pantoprozole (Protonix)
Histamine2 Blockers
Cimetidine (Tagamet)
Ranitidine hydrochloride (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)
Promotility Agents
Metoclopramide (Reglan)
 Medications of the Integumentary System
Medications used to treat skin conditions include topical and oral drugs.
Some common topical treatments for skin conditions include:
 Antibacterials: These medicines, including mupirocin or clindamycin, are often used to
treat or prevent infection.
 Anthralin : This drug, though not often used because it can be irritating and can stain,
helps reduce inflammation and can help treat psoriasis.
 Antifungal agents: Clotrimazole (Lotrimin), ketoconazole (Nizoral),
and terbinafine (Lamisil AT), are a few examples of common topical antifungal drugs
used to treat skin conditions such as ringworm and athlete's foot.
 Benzoyl peroxide: Creams, gels, washes, and foams containing benzoyl peroxide are used
to treat acne.
 Coal tar : This topical treatment is available with and without a prescription, with
strengths ranging from 0.5% to 5%. Coal tar is used to treat conditions
including seborrheic dermatitis (usually in shampoos) or psoriasis. Currently, coal tar is
seldom used because it can be slow acting and can cause severe staining of personal
clothing and bedding.
 Corticosteroids: These are used to treat skin conditions including eczema. Corticosteroids
come in many different forms including foams, lotions, ointments, and creams.
 Non-steroidal ointment: The ointments crisaborole (Eucrisa) and tacrolimus (Protopic)
and the cream pimecrolimus (Elidel) also are prescribed for eczema, including atopic
dermatitis.
 Retinoids: These medications (such as Differin, Retin-A, and Tazorac) are gels, foams,
lotions, or creams derived from vitamin A and are used to treat conditions including acne.
 Salicylic acid : This drug is sold in lotions, gels, soaps, shampoos, washes, and patches.
Salicylic acid is the active ingredient in many skin care products for the treatment of acne
and warts.
Some common oral or injection treatments for skin conditions include:
 Antibiotics: Oral antibiotics are used to treat many skin conditions. Common antibiotics
include dicloxacillin, erythromycin, and tetracycline.
 Antifungal agents: Oral antifungal drugs include fluconazole and itraconazole. These
drugs can be used to treat more severe fungal infections. Terbinafine is an oral antifungal
medicine that may be used to treat fungal infections of the nails.
 Antiviral agents: Common antiviral agents
include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Antiviral
treatments are used for skin conditions including those related to herpes and shingles.
 Corticosteroids: These medications, including prednisone, can be helpful in treating skin
conditions linked to autoimmune diseases including vasculitis and inflammatory diseases
such as eczema. Dermatologists prefer topical steroids to avoid side effects; however,
short-term use of prednisone is sometimes necessary.
 Immunosuppressants: Immunosuppressants, such as azathioprine (Imuran)
and methotrexate (Trexall), can be used to treat conditions including severe cases
of psoriasis and eczema.
 Biologics: These new therapies are the latest methods being utilized to treat psoriasis and
other conditions. Examples of biologics include adalimumab (Humira), adalimumab-atto
(Amgevita), a biosimilar to Humira, etanercept (Enbrel), etanercept-szzs (Erelzi), a
biosimilar to Enbrel, infliximab (Remicade), ixekizumab (Taltz), secukinumab
(Cosentyx), brodalumab (Siliq), ustekinumab (Stelara), guselkumab (Tremfya), risankizu
mab (Skyrizi) and tildrakizumab (Ilumya).
 Enzyme inhibitors: Enzyme inhibitors such as apremilast (Otezla) shuts down an enzyme
in the immune system to fight inflammation. Eucrisa ointment is an enzyme inhibitor
FDA approved for mild to moderate atopic dermatitis/eczema.
 Medications for Muscular System
Anticholinergics – helps to relax smooth muscles, ex. atropine
Drugs such as adrenoceptor agonists, muscarinic agonists, nitrates, and calcium channel blockers
all affect smooth muscle. Hormones can also influence smooth muscle function. Apart from
histamine, agents known to function as local hormones are prostanoids. 
Common drug classes used to treat musculoskeletal conditions are benzodiazepines, muscle
relaxants, SNRIs, muscle relaxant / NSAID combinations, and muscle relaxant / opioid /
NSAID Combinations.
The classes of CV drugs included antithrombotic agents (ATC code B01), diuretics (C03), beta-
blockers (C07), calcium channel blockers (C08), renin-angiotensin system (RAS)-acting agents
(C09), lipid-lowering drugs (C10), and cardiac drugs (C01).
 Anticoagulants
 Antiplatelet Agents and Dual Antiplatelet Therapy
 ACE Inhibitors
 Angiotensin II Receptor Blockers
 Angiotensin Receptor-Neprilysin Inhibitors
 Beta Blockers
 Calcium Channel Blockers
 Cholesterol-lowering medications
 Digitalis Preparations
 Diuretics
 Vasodilators
Anticoagulants
(Also known as Blood Thinners.)
Commonly prescribed include:
 Apixaban (Eliquis) 
 Dabigatran (Pradaxa)
 Edoxaban (Savaysa)
 Heparin (various)
 Rivaroxaban (Xarelto)
  Warfarin (Coumadin)
What the Medication Does
Decreases the clotting (coagulating) ability of the blood. Sometimes called blood thinners,
although they do not actually thin the blood. They do NOT dissolve existing blood clots. Used to
treat certain blood vessel, heart and lung conditions.
Reason for Medication
 Helps to prevent harmful clots from forming in the blood vessels.
 May prevent the clots from becoming larger and causing more serious problems.
 Often prescribed to prevent first or recurrent stroke.
Antiplatelet Agents and Dual Antiplatelet Therapy (DAPT)
Commonly prescribed include:
 Aspirin
 Clopidogrel (Plavix)
 Dipyridamole (Persantine)
 Prasugrel (Effient)
 Ticagrelor (Brilinta)
What the Medication Does
Keeps blood clots from forming by preventing blood platelets from sticking together.
Reason for Medication
 Helps prevent clotting in patients who have had a heart attack, unstable angina, ischemic
strokes, TIA (transient ischemic attacks) and other forms of cardiovascular disease.
 Can also be prescribed preventively when plaque buildup is evident but there is not yet a
major blockage in the artery.
 Certain patients will be prescribed aspirin combined with another antiplatelet drug – also
known as dual antiplatelet therapy (DAPT). 
Dual Antiplatelet Therapy (DAPT)
Some patients who have heart attacks, that have stents placed in their coronary arteries, or
undergo coronary artery bypass graft surgery (CABG) are treated with two types of antiplatelet
agents at the same time to prevent blood clotting. This is called dual antiplatelet therapy (DAPT).
One antiplatelet agent is aspirin. Almost everyone with coronary artery disease, including those
who have had a heart attack, stent, or CABG are treated with aspirin for the rest of their lives. A
second type of antiplatelet agent, called a P2Y12 inhibitor, is usually prescribed for months or
years in addition to the aspirin therapy.
The type of medication and the duration of your treatment will vary based on your condition and
other risk factors. The risks and benefits of DAPT should be discussed with your health care
provider.
 If you did not have a heart attack, but have atherosclerosis in your coronary
arteries and had a stent placed, in addition to aspirin, you should be on clopidogrel for
at least 1-6 months, depending on the type of stent which was placed, risk of clotting the
stent, and bleeding risk. 
 If you had a heart attack and a coronary artery stent placed, or you are being
treated with medical therapy (no stent, clot buster or surgery), in addition to aspirin,
you should also be on a P2Y12 inhibitor for 6-12 months. In some cases, it may be
advisable to be on DAPT longer. This will need to be discussed with your healthcare
provider. The three P2Y12 inhibitors currently available that could be prescribed are
clopidogrel, prasugrel, and ticagrelor. Studies have shown that two of these drugs
(ticagrelor, prasugrel) are “stronger” than clopidogrel, and are a little better at decreasing
the complications of blood clots. These two stronger agents, however, slightly increase
bleeding. One of these drugs (prasugrel) should not be used by patients who have had a
stroke or a transient ischemic attack (TIA). You will be prescribed the drug that is best
for you, based on your risk of blood clots and bleeding. For example, according to
the FDA(link opens in new window)(link opens in new window)(link opens in new
window), clopidogrel does decrease the risk of stroke and MI, but does not change the
risk of death for specific patients. The choice of what type of medication, cost of the
medication and duration of treatment will be determined in discussions with your health
care provider.
 Some patients who undergo coronary artery bypass surgery may be treated with a
P2Y12 inhibitor for a year after the bypass operation. After this, the P2Y12 inhibitor might
be stopped, but aspirin is usually continued long-term. Your surgeon will discuss if this
treatment will be needed.
These are general recommendations for the duration and type of dual anti-platelet therapy which
could be used after coronary artery stenting, heart attack and CABG. Again, it is important to
talk to your health care provider about your treatment plan.
Print a patient information sheet on DAPT (PDF).
Angiotensin-Converting Enzyme (ACE) Inhibitors
Commonly prescribed include:
 Benazepril (Lotensin)
 Captopril (Capoten)
  Enalapril (Vasotec)
 Fosinopril (Monopril)
 Lisinopril (Prinivil, Zestril)
 Moexipril (Univasc)
 Perindopril (Aceon)
 Quinapril (Accupril)
 Ramipril (Altace)
 Trandolapril (Mavik) 
What the Medication Does
Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows
blood to flow more easily and makes the heart's work easier or more efficient.
Reason for Medication
 Used to treat or improve symptoms of cardiovascular conditions including high blood
pressure and heart failure.
Angiotensin II Receptor Blockers (or Inhibitors)
(Also known as ARBs)
Commonly prescribed include:
 Azilsartan (Edarbi)
 Candesartan (Atacand)
 Eprosartan (Teveten)
 Irbesartan (Avapro)
 Losartan (Cozaar)
 Olmesartan (Benicar) 
 Telmisartan (Micardis) 
 Valsartan (Diovan) 
What the Medication Does
Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor
blockers prevent this chemical from having any effect on the heart and blood vessels. This keeps
blood pressure from rising.
Reason for Medication
  Used to treat or improve symptoms of cardiovascular conditions including high blood
pressure and heart failure.

Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

ARNIs are a drug combination of a neprilysin inhibitor and an ARB.
Commonly prescribed include:
 Sacubitril/valsartan (Entresto)
What the Medication Does
Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed
arteries. By limiting the effect of neprilysin, it increases the effects of these substances and
improves artery opening and blood flow, reduces sodium (salt) retention, and decreases strain on
the heart.
Reason for Medication
 For the treatment of heart failure
Beta Blockers
(Also known as Beta-Adrenergic Blocking Agents)
Commonly prescribed include:
 Acebutolol (Sectral)
 Atenolol (Tenormin)
 Betaxolol (Kerlone)
 Bisoprolol/hydrochlorothiazide (Ziac)
 Bisoprolol (Zebeta)
 Metoprolol (Lopressor, Toprol XL)
 Nadolol (Corgard)
 Propranolol (Inderal)
 Sotalol (Betapace)
What the Medication Does
Decreases the heart rate and force of contraction, which lowers blood pressure and makes the
heart beat more slowly and with less force.
Reason for Medication
  Used to lower blood pressure.
 Used for cardiac arrhythmias (abnormal heart rhythms)
 Used to treat chest pain (angina)
 Used to help prevent future heart attacks in patients who have had a heart attack.
Combined Alpha and Beta-Blockers
Combined alpha and beta-blockers are used to treat high blood pressure and heart failure.
Commonly prescribed include:
 Carvedilol (Coreg, Coreg CR)
 Labetalol hydrochloride (Normodyne, Trandate)
A noted possible side effect of combined alpha and beta-blockers:
 May cause a drop in blood pressure when you stand up
Calcium Channel Blockers
(Also known as Calcium Antagonists or Calcium Blockers)
Commonly prescribed include:
 Amlodipine (Norvasc)
 Diltiazem (Cardizem, Tiazac)
 Felodipine (Plendil)
 Nifedipine (Adalat, Procardia)
 Nimodipine (Nimotop)
 Nisoldipine (Sular)
 Verapamil (Calan, Verelan)
What the Medication Does
Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease
the heart's pumping strength and relax blood vessels.
Reason for Medication
 Used to treat high blood pressure, chest pain (angina) caused by reduced blood supply to
the heart muscle and some arrhythmias (abnormal heart rhythms).
Cholesterol-Lowering Medications
  Statins: Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor), Pitavastatin
(Livalo), Pravastatin (Pravachol), Rosuvastatin (Crestor), Simvastatin (Zocor)
 Nicotinic acids: Niacin
 Cholesterol absorption inhibitor: Ezetimibe (Zetia)
 Combination statin and cholesterol absorption inhibitors: Ezetimibe/Simvastatin
(Vytorin)
What the Medication Does
Various medications can lower blood cholesterol levels, but drugs other than statins are usually
only used for patients in whom statins are not effective or who have serious side effects from
statin therapy. They work in the body in different ways. Some affect the liver, some work in the
intestines and some interrupt the formation of cholesterol from circulating in the blood. Watch an
animation of how statins work.
Reason for Medication
Used to lower LDL ("bad") cholesterol.
*Some cholesterol-lowering medications may interact with grapefruit, grapefruit juice,
pomegranate and pomegranate juice. Please talk to your health care provider about any
potential risks. 
Digitalis Preparations 
Commonly prescribed include:
 Digoxin (Lanoxin)
What the Medication Does
Increases the force of the heart's contractions. Can be beneficial in treating heart failure and
irregular heartbeats.
Reason for Medication
 Used to relieve heart failure symptoms, especially when the patient isn't responding to
other standard treatments including ACE inhibitors, ARBs and diuretics.
 Also slows certain types of irregular heartbeat (arrhythmias), particularly atrial
fibrillation.
Diuretics
(Also known as Water Pills)
Commonly prescribed include:
 Acetazolamide (Diamox)
  Amiloride (Midamor)
 Bumetanide (Bumex)
 Chlorothiazide (Diuril)
 Chlorthalidone (Hygroton)
 Furosemide (Lasix)
 Hydro-chlorothiazide (Esidrix, Hydrodiuril)
 Indapamide (Lozol) 
 Metalozone (Zaroxolyn)
 Spironolactone (Aldactone)
 Torsemide (Demadex)
What the Medication Does
Causes the body to rid itself of excess fluids and sodium through urination. Helps to reduce the
heart's workload. Also decreases the buildup of fluid in the lungs and other parts of the body,
such as the ankles and legs. Different diuretics remove fluid at varied rates and through different
methods.
Reason for Medication
 Used to help lower blood pressure.
 Used to help reduce swelling (edema) from excess buildup of fluid in the body.
Vasodilators
Commonly prescribed include:
 Isosorbide dinitrate (Isordil)
 Isosorbide mononitrate (Imdur)
 Hydralazine (Apresoline)
 Nitroglycerin (Nitro Bid, Nitro Stat)
 Minoxidil
What the Medication Does
Relaxes blood vessels and decreases blood pressure. 
A category of vasodilators called nitrates increases the supply of blood and oxygen to the heart
while reducing its workload which can ease chest pain (angina). Nitroglycerin is available as a
pill to be swallowed or absorbed under the tongue (sublingual), a spray, and as a topical
application (cream).
Reason for Medication
 Used to ease chest pain (angina)
 Medications for the Lymphatic System
Drugs acting on the lymphatic system
The lymphatic system is part of immune system. The components of the lymphatic
systeminclude: lymph nodes, thymus, spleen, bone marrow, tonsils and lymph fluid. Lymphomas
is acancer of the lymphatic system and can be classified as Hodgkin’s lymphoma and the non-
Hodgkin’s lymphoma. The symptoms of lymphomas can include swelling of the lymph
nodes,fever, night sweats and weight loss.
The following list of medications are in some way related to or even used to treat in the
treatmentof this condition.
Chemotherapy drugs are commonly used to treat lymphomas. These drugs keep them
frommultiplying. The lymphoma drugs can be classified as, Hodgkin’s chemo drugs, Non-
Hodgkin’schemo drugs and Non-Hodgkin’s immunotherapy drugs.

Hodgkin’s lymphoma chemotherapy drugs

Chemotherapy drugs are medications used alone or in combination to target lymphoma cells.
These drugs kill cancer cells or keep them from multiplying. Chemotherapy medications can
treat Hodgkin’s lymphoma.
Chemotherapy medications often involve combining several drugs together for optimum results.
Doctors give the medications via an intravenous (IV) treatment. Special IV lines called a port or
port-a-cath are used to deliver these medications. The port provides access to a large vein,
usually in the chest. This prevents vein damage from the strong medications.
Three chief chemotherapy regimens for Hodgkin’s lymphoma exist.
ABVD includes the following drugs:
 doxorubicin (Adriamycin)
 bleomycin (Blenoxane)
 vinblastine (Velban)
 dacarbazine (DTIC-Dome)
BEACOPP includes the following drugs:
 bleomycin (Blenoxane)
 etoposide (Etopophos, Toposar, VePesid, VP-16)
 doxorubicin (Adriamycin)
 cyclophosphamide (Cytoxan)
 vincristine (Oncovin)
  procarbazine (Matulane)
 prednisone (Rayos, Prednisone Intensol)
Stanford V includes the following drugs:
 mechlorethamine (Mustargen)
 doxorubicin (Adriamycin)
 vinblastine (Velban)
 vincristine (Oncovin)
 bleomycin (Blenoxane)
 etoposide (Etopophos, Toposar, VePesid, VP-16)
 prednisone (Rayos, Prednisone Intensol)
Doctors prescribe the Stanford V regimen to people with advanced lymphoma. Doctors are more
likely to prescribe the ABVD regimen for earlier stages.
Non-Hodgkin’s lymphoma chemotherapy drugs
Doctors prescribe chemotherapy to treat NHL, as well. Similar to drugs used for Hodgkin’s
lymphoma treatments, pharmacists mix several chemotherapy medications together. These
medication types fall into six categories. Doctors select a medication based on the lymphoma
type and stage.
Alkylating agents
These drugs keep cells from replicating by destroying DNA. While effective, they’re associated
with an increased risk for leukemia. Examples include:
 cyclophosphamide (Cytotoxan)
 chlorambucil (Leukeran)
 bendamustine (Treanda)
 ifosfamide (Ifex)
Corticosteroids
Corticosteroids kill cancerous cells, prevent the cancerous cells from growing, and can
reduce nausea. Examples of these medications include:
 prednisone (Rayos, Prednisone Intensol)
 dexamethasone (Decadron)
Platinum drugs
Platinum drugs work similarly to alkylating agents, but they don’t pose an increased risk for
leukemia. Examples of these drugs include:
 carboplatin (Paraplatin)
 cisplatin (Platinol)
 oxaliplatin (Eloxatin)
Purine analogs
Purine analogs reduce cell metabolism to keep cancerous cells from reproducing and dividing.
Medication examples include:
 cladribine (2-CdA, Leustatin)
 fludarabine (Fludera)
 pentostatin (Nipent)
Antimetabolites
These drugs prevent DNA and RNA from growing and killing the cancerous cells. Examples
include:
 capecitabine (Xeloda)
 cytarabine (ara-C)
 gemcitabine (Gemzar)
 methotrexate (Trexall)
 pralatrexate (Folotyn)
Additional medications
Additional medications used to treat lymphoma that don’t fit into a particular category include:
 bleomycin (Blenoxane)
 doxorubicin (Adriamycin)
 etoposide (Etopophos, Toposar, VePesid, VP-16)
 mitoxantone (Novantrone)
 vincristine (Oncovin)
According to the American Cancer Society (ACS)Trusted Source, CHOP is a common NHL
chemotherapy regimen. Pharmacists combine the following drugs:
 cyclophosphamide (Cytotxan)
 doxorubicin (hydroxydoxorubicin)
  vincristine (Oncovin)
 prednisone (Rayos, Prednisone Intensol)
Doctors may add rituximab (Rituxan) to this regimen, which is known as R-CHOP. According to
the Leukemia & Lymphoma Society (LLS), the R-CHOP regimen treats more aggressive forms
of NHL. This method can cure NHL in some people.
The combination of cyclophosphamide, vincristine, and prednisone (CVP) is another regimen.
Non-Hodgkin’s lymphoma immunotherapy drugs
Immunotherapy can boost the body’s immune system to fight cancer in people with NHL. In
addition to fighting cancer, immunotherapy drugs can minimize some of chemotherapy’s side
effects, including nausea and fatigue.
These medications are often called guided missiles. They specifically target cancer cells. Other
chemotherapy medications can harm healthy cells that multiply quickly, such as hair cells.
Immunotherapy medications that treat NHL include:
 immune modulators, including thalidomide (Thalomid) and lenalidomide (Revlimid)
 monoclonal antibodies, such as rituximab (Rituxan)
 proteasome inhibitors, such as bortezomib (Velcade)
 small molecule treatments, such as panobinostat (Farydak)
A doctor may prescribe these or other treatments, depending upon the person’s NHL type.
R-CHOP Chemotherapy: Side Effects, Dosage, and More
 Usage
 Mechanism
 Dosage and administration
 Side effects
 Tips
 Takeaway
What is R-CHOP chemotherapy?
Chemotherapy drugs can shrink tumors or kill stray cancer cells left behind after surgery or
radiation. It’s also a systemic treatment, meaning its purpose is to kill cancer cells throughout
your body.
All chemotherapy drugs work to kill cancer cells, but they do it in different ways. This is why
oncologists often choose a combination of drugs. They base their choices on factors such as the
type of cancer you have, how far it has spread, and your overall health.
R-CHOP includes five chemotherapy drugs:
 rituximab (Rituxan)
 cyclophosphamide
 doxorubicin hydrochloride
 vincristine (Oncovin, Vincasar PFS)
 prednisolone
You can get R-CHOP with or without other treatments such as surgery and radiation therapy.
Learn more: Common types of chemotherapy for breast cancer »
What does R-CHOP treat?
Doctors mainly use R-CHOP to treat non-Hodgkin lymphoma (NHL) and other lymphomas.
Lymphoma is cancer that begins in the lymphatic system.
R-CHOP can also treat other types of cancer.
How does R-CHOP work?
Three of the drugs in R-CHOP are powerful cytotoxics, which means they kill cells. One is a
type of immunotherapy and the last is a steroid, which has shown to have anticancer effects.
Rituximab (Rituxan)
Rituximab is generally used to treat NHL. It’s a monoclonal antibody. It targets a protein called
CD20 on the surface of white blood cells called “B cells. Once the drug attaches to the B cells,
your immune system attacks and kills them.
Cyclophosphamide (Cytoxan)
This drug can treat a variety of cancers, including lymphoma and cancer of the breast and lung.
Cyclophosphamide targets the DNA of cancer cells and signals them to stop dividing.
Doxorubicin hydrochloride (Adriamycin, Rubex)
This drug is an anthracycline that can treat many types of cancer, including breast, lung, and
ovarian cancer. Doxorubicin blocks an enzyme cancer cells need to grow and reproduce. It’s
bright red color has earned it the nickname “the red devil.”
Vincristine (Oncovin, Vincasar PFS, Vincrex)
Vincristine is an alkaloid that can treat many types of cancer, including advanced-stage breast
cancer, lymphomas, and leukemia. It interferes with genes to stop them from replicating. This
drug is a vesicant, meaning it can damage tissue and vessels.
Prednisolone
This drug is a corticosteroid available under a variety of brand names. Unlike the others, this is
an oral medication. It works with your immune system to help reduce:
 inflammation
 nausea
 vomiting
 allergic reactions
 low platelet levels, or thrombocytopenia
 high calcium levels, or hypercalcemia
 Medications for the Endocrine System

Peptides
Aminoacid derivates
Steroids
Hypothalamic hormones
Thyroid stimulating hormone (TSH)
Follicle-stimulating hormone
Luteinizing hormone
Thyroid hormones
Antithyroid drugs
Synthetic hypoglycemic agents
Glucocorticoids
Mineralocorticoids
Oestrogens
Antioestrogens
Progestogens
Hormonal contraceptives
Masculine gonadal hormones
 Medications for the Nervous System
There are several categories of drugs used to treat disorders of the nervous system:
anticonvulsants; tranquilizers, sedatives, and analgesics; and psychotropic agents.
Anticonvulsant Drugs
Anticonvulsant drugs are used to control seizures, including those caused by epilepsy. In
epilepsy, treatment is essential to prevent overheating, brain damage, and disruption to the
body’s circulation. Such drugs are usually given by mouth when used for longterm maintenance
treatment. These drugs are usually started at a low dose, which is gradually adjusted until control
of seizures occurs. To discontinue a drug, even when changing drugs, the dose should be tapered
gradually to avoid triggering a seizure. During a seizure that lasts a long time (continues for
several minutes), also called status epilepticus, anticonvulsants are given intravenously.
Tranquilizers, Sedatives, and Analgesics
Tranquilizers reduce anxiety and gives a sense of calm without drowsiness. Drugs used to induce
sedation have a more profound effect and produce drowsiness and hypnosis. Analgesia is the
reduction of pain, which according to a drug’s effect, may be more pronounced in either the body
organs or the musculoskeletal system. A number of drugs may be used in animals for
tranquilization, sedation, and analgesia. Many psychotropic drugs can function as either
tranquilizers or sedatives according to the dose administered, and many sedatives are also
analgesics. Also, drugs classified as tranquilizers, sedatives, or analgesics may have additional
uses, such as behavior modification or control of nausea and vomiting.
Psychotropic Agents
Anxiolytics, antipsychotics, antidepressants, and mood stabilizers used in people are being used
more commonly in veterinary medicine as aids to behavior modification treatment.
Anxiolytics have been used to treat generalized anxiety and panic disorder in humans and may
help alleviate or diminish certain fear-related behaviors in animals (for example, thunderstorm
anxiety in dogs and social anxiety in cats). Antipsychotics are used for nonselective
tranquilization and diminishing behavioral arousal. Mood-stabilizing drugs are used in human
medicine to treat bipolar disorder, impulsivity, emotional reactivity, and aggression. They may
be used occasionally in animals (for example, to treat fear-related
aggression). Antidepressants can be used to treat behavioral disorders, including compulsive
behaviors, aggression, and inappropriate elimination. These drugs are classified as tricyclic
compounds (tertiary amines, secondary amines), selective serotonin-reuptake inhibitors, and
atypical antidepressants.

There are many different types of drugs that work on the CNS, including anesthetics,
anticonvulsants, antiemetics, antiparkinson agents, CNS stimulants, muscle relaxants, narcotic
analgesics (pain relievers), nonnarcotic analgesics (such as acetaminophen and NSAIDs), and
sedatives
Central nervous system agents
Other names: CNS agents
What are Central nervous system agents?
Central nervous system agents are medicines that affect the central nervous system (CNS). The
CNS is responsible for processing and controlling most of our bodily functions, and consists of
the nerves in the brain and spinal cord.
There are many different types of drugs that work on the CNS, including anesthetics,
anticonvulsants, antiemetics, antiparkinson agents, CNS stimulants, muscle relaxants, narcotic
analgesics (pain relievers), nonnarcotic analgesics (such as acetaminophen and NSAIDs), and
sedatives.
Types of Central nervous system agents
Please refer to the drug classes listed below for further information.
 adrenergic uptake inhibitors for ADHD
 analgesics
o analgesic combinations
o antimigraine agents
o CGRP inhibitors
o cox-2 inhibitors
o miscellaneous analgesics
o narcotic analgesic combinations
o narcotic analgesics
o Nonsteroidal anti-inflammatory drugs
o salicylates
 anorexiants
 anticonvulsants
o AMPA receptor antagonists
o barbiturate anticonvulsants
o benzodiazepine anticonvulsants
o carbamate anticonvulsants
o carbonic anhydrase inhibitor anticonvulsants
 o dibenzazepine anticonvulsants
o fatty acid derivative anticonvulsants
o gamma-aminobutyric acid analogs
o gamma-aminobutyric acid reuptake inhibitors
o hydantoin anticonvulsants
o miscellaneous anticonvulsants
o neuronal potassium channel openers
o oxazolidinedione anticonvulsants
o pyrrolidine anticonvulsants
o succinimide anticonvulsants
o triazine anticonvulsants
 antiemetic/antivertigo agents
o 5HT3 receptor antagonists
o anticholinergic antiemetics
o miscellaneous antiemetics
o NK1 receptor antagonists
o phenothiazine antiemetics
 antiparkinson agents
o anticholinergic antiparkinson agents
o dopaminergic antiparkinsonism agents
o miscellaneous antiparkinson agents
 anxiolytics, sedatives, and hypnotics
o barbiturates
o benzodiazepines
o miscellaneous anxiolytics, sedatives and hypnotics
 cholinergic agonists
 cholinesterase inhibitors
 CNS stimulants
  drugs used in alcohol dependence
 general anesthetics
 miscellaneous central nervous system agents
 muscle relaxants
o neuromuscular blocking agents
o skeletal muscle relaxant combinations
o skeletal muscle relaxants
 VMAT2 inhibitors
https://www.drugs.com/drug-class/central-nervous-system-agents.html
Parasympathomimetics are a class of medications that activate the parasympathetic nervous
system by mimicking or modifying the effects of acetylcholine. These drugs include muscarinic
receptor agonists (direct-acting parasympathomimetics) and acetylcholinesterase inhibitors
(indirect-acting parasympathomimetics).
 Medications for the Skeletal system
Antiresorptive therapies include use of bisphosphonates, estrogen, selective estrogen receptor
modulators (SERMs), and calcitonin. Antiresorptive therapies reduce bone loss, stabilize the
microarchitecture of the bone, and decrease bone turnover—all leading to fracture reduction.
Drugs that affect skeletal muscle function fall into several categories. Some, such
as neuromuscular blocking agents, are used during surgery to produce paralysis. Others, such
as skeletal muscle relaxants, reduce muscle rigidity and spasms associated with various
neurologic and musculoskeletal conditions. In addition, there are several drugs that influence
metabolic and other processes in skeletal muscle, including the nutrients that are required for
normal muscle function and that are used to prevent or lessen degenerative muscular conditions.
For example, selenium and vitamin E are used to prevent or treat muscular dystrophies such as
white muscle disease in foals. The steroidal, nonsteroidal, and various other anti-inflammatory
drugs are also commonly used to treat short- and longterm inflammatory conditions involving
skeletal muscle. Anabolic steroids promote muscle growth and development and are
administered in selected cases in which serious muscle deterioration has developed as a
complication of another disease.
 Medications for the reproductive system
Drugs used to regulate and control the reproductive system are often naturally
occurring hormones or chemical modifications of hormones. These are often used to induce or
suppress estrus, the time during the reproductive cycle in animals when the female displays
interest in mating, often called “heat.” Some are also used to stimulate testicular function or
sperm production. Some of the more commonly used hormones include gonadotropin-releasing
hormone and related drugs, follicle-stimulating hormone, human chorionic gonadotropin, equine
chorionic gonadotropin, estradiol compounds, progesterone and synthetic progestins,
testosterone, and prostaglandins. Another hormone, oxytocin, is used to promote milk production
and letdown and to cause contraction of the uterus to either induce labor or to enhance
contraction of the uterus after the birth.
Female
Sex hormones
 Estrogen
 Progestin
 Estrogen receptor modulators
 Fertility drugs
Uterine motility
 Oxytocic
 Abortifacients

Male
 Androgens
 Anabolic Steroids
 Penile Erectile Dysfunction Drugs
 Medications for the Respiratory System
Drugs used to treat respiratory conditions fall into several categories: cough suppressants,
bronchodilators, expectorants, and decongestants. Antibiotics and anti-inflammatory drugs are
also important in the treatment of many respiratory diseases.
Cough Suppressants
Cough suppressants stifle the coughing reflex. Most cough suppressants are narcotics that act
directly on the part of the brain that prompts coughing, the medulla oblongata. Morphine is an
effective cough suppressant at doses lower than those used to control pain or sedate. However, it
is not commonly used because of its side effects. Codeine is found in many preparations,
including tablets, liquids, and syrups. Hydrocodone is similar to codeine but is stronger. It is
combined with an anticholinergic drug to discourage abuse by people. Dextromethorphan is not
technically an opioid because it does not behave in the same way in the body and is not addictive
or analgesic. Butorphanol is used as a painkiller and cough suppressant.
When prescribing a cough suppressant, your veterinarian will take into consideration the fact that
some are not safe for use in cats. You should never give over-the-counter preparations intended
for human use to your pet unless directed by a veterinarian.
Bronchodilators
In certain airway disorders, breathing becomes difficult because the muscles surrounding the
airways constrict. Bronchodilators relieve this constriction by relaxing the muscles, which opens
the airways and allows air to move more easily in and out of the lungs. Bronchodilators may also
help relieve inflammation and clear mucus from the lungs. There are several categories of
bronchodilators.
The beta-adrenergic agonists have beneficial effects in the treatment of bronchoconstrictive
airway diseases. These have been shown to relax the bronchial smooth muscle, decrease the
inflammatory response in the airways, and help the cilia clear mucus from the respiratory tract.
Themethylxanthines are also used as bronchodilators. They cause relaxation of the bronchial
smooth muscles, stimulation of the central nervous system, and mild heart stimulation.
Methylxanthines also decrease the inflammatory response in the airways and help the cilia clear
mucus from the respiratory system.
Anticholinergic drugs are effective bronchodilators that act by reducing the sensitivity of
irritant receptors and inhibiting smooth muscles in the respiratory tract.
Anti-inflammatory Drugs
Glucocorticoids (a type of corticosteroids) help control inflammation of the airways by
preventing the body’s release of inflammatory chemicals. Because they suppress the immune
system, glucocorticoids are generally not used in treating infectious respiratory diseases. In cases
of severe attacks of allergic bronchitis, asthma, or recurrent airway inflammation, injection of
glucocorticoids usually provides rapid relief. For longterm treatment in dogs and cats, oral
treatment is usually used.
Antibiotics
Antibiotic treatment may or may not be necessary in the treatment of inflammatory airway
diseases. Antibiotics may be prescribed when a true bacterial infection is present or when
infection is making existing airway disease worse.
Inhalation Treatment
With inhalation treatment, high drug concentrations are delivered directly to the lungs by
nebulizers or metered-dose inhalers. This helps to avoid or minimize certain adverse effects.
Also, the drug’s effects are seen more rapidly than with other delivery methods. Drugs available
in metered-dose inhalers include several bronchodilators and anti-inflammatory drugs.
Expectorants and Mucus-producing Drugs
Expectorants and mucus-producing drugs make coughs more productive. They do this by
increasing the amount of bronchial secretions, in addition to thinning the secretions. This clears
the airways and eases breathing. They are usually given by mouth, although some can be
nebulized and inhaled.
Decongestants
Decongestants, though commonly used in people to treat the sneezing and runny nose associated
with allergies or hay fever, are rarely used for this purpose in animals. The alpha-adrenergic
agonist drugs cause local constriction of the blood vessels, reducing swelling and edema. They
can be used topically as nasal decongestants in allergic or viral rhinitis. They can also be used
systemically with antihistamines as respiratory tract decongestants. Antihistamines, when
combined with alpha-adrenergic agonist drugs, are effective for treatment of allergic rhinitis in
humans, but the effectiveness in animals is inconsistent.

Table 1. Some Frequently Used Medications for Respiratory

Disorders

Category Generic name

Albuterol
Levalbuterol
Salmeterol
Bronchodilators Formoterol
 Racemic epinephrine
Fluticasone
Corticosteroids Budesonide

Mometasone furoate
Mast cell stabilizers/Anti-IgE antibodies Nedocromil

Cromolyn Sodium
Leukotriene receptor antagonists Omalizumab

Zafirlukast
Montelukast
Antihistamines, hyposensitization, and allergic emergencies Zileuton

Loratidine
Fexofenadine
Cetirizine
Respiratory stimulants Epinephrine

Doxapram
Theophylline
Progesterone
Pulmonary surfactants Caffeine

Colfosceril palmitate
Beractant
Calfactant
Oxygen Antimicrobials Poractant alfa

Pentamidine
Antivirals Tobramycin

Expectorant Miscellaneous Ribavirin

Zanamivir
Guaifenisin
Varenicline
 Medications for the Urinary System
Drugs used to treat urinary disorders include antibiotics and antifungal medications for
infections, diuretics for kidney failure, and a variety of other drugs for several other disorders.
Antibiotics
Antibiotic drugs are the basis of urinary tract infection treatment. Antibiotic treatment involves
determining the type of bacteria present and choosing the appropriate drug. There are many types
of antibiotics; your veterinarian will prescribe one that is excreted in an active form in the urine
and is known to be effective against the particular bacteria present.
Many animals with recurrent urinary tract infections are treated with repeated courses of
antibiotics. However, if the underlying cause of the infection is not found, the repeated courses
of antibiotics can do more harm than good. Inappropriate treatment with the wrong antibiotic can
cause bacteria to become resistant (see Guidelines for the Use of Antibiotic Drugs). Chronic
urinary tract infections from highly resistant bacteria are very hard to treat.
If episodes occur more than once or twice yearly, and the causes of the urinary tract infections
cannot be found or corrected, longterm low-dose treatment with oral antibiotics may be
necessary to prevent new episodes.
Antifungal Drugs
Although uncommon, fungal urinary tract infections occur in dogs and cats. Treatment involves
removing any predisposing factors (excessive corticosteroids, urinary catheters) and giving
antifungal drugs, with or without urinary alkalinization (see Controlling Urine pH).
Controlling Urine pH
Controlling Urine pH
pH is the measure of how acidic or alkaline (basic) a substance is. Urine with abnormally high or
low pH can contribute to the formation of certain types of kidney or bladder stones. In dogs,
urine pH should be between 7 and 7.5. In cats, it should be between 6.3 and 6.6. Potassium
citrate can be used to raise the pH, making it more alkaline (basic). Ammonium
chloride or DL-methionine can be used to lower the pH, making it more acidic.
Cystine-binding Agents
Cystinuria, with the formation of cystine kidney stones, is caused by an inherited disorder.
Cystine kidney stones are dissolved with changes in the diet, urinary alkalinization or
neutralization, and the use of cystine-binding agents. Once stones are dissolved, changes in the
diet can help prevent them from coming back.
Diuretics
Diuretics are used to remove excess water from animals with swelling or volume overload, such
as that which occurs with kidney failure. There are several classes of diuretics, grouped by the
way they act in the body (see Table: Diuretics*). Loop diuretics are named because of their
effect on the ascending loop of Henle in the kidney. Carbonic anyhdrase inhibitors work by
decreasing the formation of carbonic acid, making more sodium bicarbonate, which takes water
with it when it is excreted. Carbonic anhydrase inhibitors also enhance potassium
excretion. Thiazide diuretics are infrequently used, but they may be given to animals that
cannot tolerate the more potent loop diuretics. Thiazides can be combined with loop or
potassium-sparing diuretics. They may also be used to treat diabetes insipidus, which affects the
kidneys. Potassium-sparing diuretics do not cause the loss of potassium, which is beneficial in
some conditions in which potassium levels may be low. These are usually used in combination
with other diuretics, rather than alone. Osmotic diuretics keep water from being reabsorbed in
the kidneys.
 Medications of the Circulatory System
Many of the drugs used to treat heart disease in animals are the same medications used in people.
Positive Inotropes
Positive inotrope drugs increase the strength of the heart muscle by increasing the amount of
calcium available for binding to muscle proteins. Increasing the amount of available calcium is
done in different ways depending on the drug used. There are 3 classes of positive inotropes:
cardiac glycosides, beta-adrenergic agonists, and phosphodiesterase inhibitors.
Angiotensin-converting Enzyme (ACE) Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are widely used to treat chronic congestive
heart failure in dogs and cats. When angiotensin-converting enzyme formation is prevented, the
narrowing of the blood vessels that is common in dogs with congestive heart failure is prevented.
It also helps reduce the buildup of sodium and water in the body, which is another side effect of
congestive heart failure. The use of these inhibitors helps increase the output of the heart and
increases the animal’s ability to exercise safely.
Vasoactive Drugs
Vasoactive drugs dilate or widen the blood vessels. There are 2 types of dilators. Arterial
dilators are drugs that dilate the arterioles, which makes it easier for the heart to pump blood
away from itself. Venous dilators dilate the veins coming to the heart and increase the amount
of blood that enters the heart.
Antiarrhythmics
Antiarrhythmics help the heart beat in its normal, rhythmic pattern. There are 4 classes of
antiarrhythmics, grouped according to how they affect the heart cells.
Hematinics
Hematinics are drugs that increase the amount of hemoglobin (the portion of the red blood cell
that carries oxygen throughout the body) and the number of red blood cells in the blood. These
are used to treat anemia, a condition in which there are low numbers of red blood cells and too
little hemoglobin.
Hemostatics
Hemostatics are used to help the blood clot. There are several types of drugs that function as
hemostatics. Lyophilized concentrates are applied to the skin or to a particular area to help
control capillary (small blood vessel) bleeding. These products are normally absorbed by the
body. Astringents are used directly at the site of bleeding to control bleeding. They constrict the
blood vessels and tissue to help slow and stop the blood
flow. Epinephrine and norepinephrine are used to constrict the blood vessels and decrease
blood flow to the tissues. Systemic hemostatics include fresh blood or blood components that
are given to animals that cannot clot correctly.
Anticoagulants
Blood clots can be a serious problem. They can cause strokes or circulation problems and can
block blood flow to vital organs. Anticoagulant drugs are used to stop or minimize the clotting
process, usually by inactivating the body’s natural clotting factors or increasing the rate at which
the body dissolves clots.
What are Cardiovascular agents?
Cardiovascular agents are medicines that are used to treat medical conditions associated with the
heart or the circulatory system (blood vessels), such as arrhythmias, blood clots, coronary artery
disease, high or low blood pressure, high cholesterol, heart failure, and stroke.
There are many different classes of drugs that fall under the general term cardiovascular agent.
Some work directly on the blood vessels surrounding the heart, reducing how much force the
heart has to pump against. Others lower cholesterol levels and help reduce the formation of
atherosclerotic plaques which cause blood vessel narrowing. Some work in the kidneys to
increase fluid and salt loss or improve blood flow through the kidneys. The type of
cardiovascular disease the person has determines which class of cardiovascular agent to use.
Types of Cardiovascular agents
Please refer to the drug classes listed below for further information.
 agents for hypertensive emergencies
 agents for pulmonary hypertension
 aldosterone receptor antagonists
 Angiotensin Converting Enzyme Inhibitors
 angiotensin receptor blockers
 angiotensin receptor blockers and neprilysin inhibitors
 antiadrenergic agents, centrally acting
 antiadrenergic agents, peripherally acting
 antianginal agents
 antiarrhythmic agents
o group I antiarrhythmics
o group II antiarrhythmics
o group III antiarrhythmics
o group IV antiarrhythmics
o group V antiarrhythmics
 anticholinergic chronotropic agents
 antihypertensive combinations
o ACE inhibitors with calcium channel blocking agents
o ACE inhibitors with thiazides
o angiotensin II inhibitors with calcium channel blockers
o angiotensin II inhibitors with thiazides
o antiadrenergic agents (central) with thiazides
o antiadrenergic agents (peripheral) with thiazides
o beta blockers with thiazides
o miscellaneous antihypertensive combinations
o potassium sparing diuretics with thiazides
 beta-adrenergic blocking agents
o cardioselective beta blockers
o non-cardioselective beta blockers
 calcium channel blocking agents
 catecholamines
 diuretics
o carbonic anhydrase inhibitors
o loop diuretics
o miscellaneous diuretics
o potassium-sparing diuretics
o thiazide diuretics
 inotropic agents
 miscellaneous cardiovascular agents
 peripheral vasodilators
 renin inhibitors
 sclerosing agents
 vasodilators
  vasopressin antagonists
 vasopressors

https://www.drugs.com/drug-class/cardiovascular-agents.html

Medicines
 Blood-thinning medicines. ...
 Statins. ...
 Beta blockers. ...
 Nitrates. ...
 Angiotensin-converting enzyme (ACE) inhibitors. ...
 Angiotensin-2 receptor blockers (ARBs) ...
 Calcium channel blockers. ...
 Diuretics