Drug Name Category s/s Pt teaching

Albuterol- rescue Β2 agonists Increased HR, tremors, How/when to appropri-

Salmeterol- long term Bronchodilators insomnia, tolerance, ately take. Albuterol is
hypokalemia rescue only

Ipratropium (Atrovent)- Anti-cholinergics Dry mouth, constipa-

shorter Bronchodilators tion(rare if inhaled)
Tiotropium (Sprivia)- Block PSS- antagonist of
long acting acetylcholine
Theophylline Xanthines Irritability, restless ness, Serum drug monitoring,
Bronchodilators GI, Cardiac stimulation smokers metabolize
Inhibit phos- (increased HR, arrhyth- faster, COPD mainte-
phodieserase enzyme mias) CNS stimulation nance, narrow therapeu-
(excitability, insomnia, tic window
seizures) BAD DRUG

Fluticasone(Flovent) – Corticosteriods Oropharyngeal candidia- Advise pt to rinse mouth

long term inhaled Anti-inflammatory sis, after use
Budesonide (Pulmicort)- Sore throat
long term inhaled

Montelukast (singular) Leukotriene Modifiers

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

Pseudoephedrine (Su- Oral decongestants Cardiac stimulation, Precautions in preg-

dafed) Decreases blood flow to restlessness, insomnia, nancy, HTN, cardiac pts.
Phenylephrine capillaries causing tremors (Controlled substance
shrinking of nasal pas- due to meth production)
sages

Diphenhydramine (Ben- Anti-histamines Sedation, drying

adryl)- 1st gen H1 blockers Less so with 2nd gen
Loratadine (Claritin,
Alavert)- 2nd gen
Dextromethorphan Anti-tussive Sedation, dry mouth
(Delsym, Robitussin Centrally acting through
DM) medulla to suppress
cough
Guafenesin (Robitussin, Expectorants GI
Mucinex) Thin secretions

Respiratory Drugs ^
ANS Drugs
Alpha/Beta drugs
Drug Name Category S/S Uses

Epinephrine Alpha1/2 and beta 1/2 adrenergic ag- Ventricular ar- anaphylaxis
onist rhythmias, HTN,
↑BP/HR/contractility/bronchodilation angina, hypergly-
At higher doses- increases HR/O2 con- cemia(use insulin
sumption drip)
↑ MAP

Norephinephrine Alpha 1/2 and Beta 1 agonist Septic shock- ↑BP

(No rep: No respi- Beta 1 effects dominate at low doses with less tachycardia
ration: No lungs Alpha effects dominate at high doses
(No B2) Powerful vasoconstrictor that won’t
stress heart

Dobutamine B1 agonist- INOTROPE Heart failure

(Sounds like lub- ↑HR, contractibility conduction Cardiogenic shock
dub-dob=just your through AV node
heart) Continuous cardiac monitoring
Phenylephrine Alpha 1 agonist For pts who cannot
Phena1 Alpha Pure vasoconstrictor tolerate Beta effects
or when pure vaso-
(also an oral decongestant) constriction required
Used post op w/ pts
w/ low SVR

Cholinergic Agents
Drug Category s/s and cautions uses

Bethanechol Direct cholinergic ago- N/V cramps, diarrhea, Treats/prevents UTI

nist salivation, bradycardia, GERD in infants
Increases bladder tone hypotension, flushing,
and urinary excretion diaphoresis
Use sparingly due to sys-
temic PS effects and in
pts. with respiratory dis-
ease or bradycardia
 Neostigmine/ Indirect cholinergic ago- Myasthenia Gravis-
physostigmine nist chronic muscular dis-
ease results in destruc-
tion of Ach receptors

Donepezil Indirect cholinergic ago- Alzheimers Disease- pro-

(I want Alzheimer’s dis- nist gressive loss of Ach pro-
ease to be DONE with!) ducing neurons

Atropine ANTI-cholinergic Bradycardia, dilate pu-

Relaxes GI tract, inhibits pils, prior to surgery
GI secretions

Antibiotics
Drug Action Category Name Notes

Blocks cell wall Beta-Lactams → Penicillin (syphilis/dental) Not active against MRSA
synthesis Penicillin’s Amoxicillin GI side effects/rash
Amoxicillin-Clavulante (Augmen- PCN combinations like Aug-
tin)(beta-lactamase inhibitor) mentin for betalactamase
Nafcillin (MSSA/skin infections) inhibitor
Methicillin-sensitive Staphylococcus aureus

Blocks cell wall Beta-Lactams→ Cefazolin (1st gen) 1st gen- surgery prophylaxis/
synthesis Cephalosporins Cephalexin (1st gen) (Glenn) skin infection
Cefoxitin (2nd gen) -Res tract infections
Ceftriaxone (3rd gen): cleared by liver 3/4 for CNS can cross BBB
(not kidney like the rest of them) GI/bleeding and effective
Cefepime (4th gen) for menengitis
(As you go up the generations (1, 2, 3, 4)
your gram negative coverage increases)
(For ones cleared by the kidneys-
you need to adjust the dose or
they may get seizures)

Blocks cell wall Beta-Lactams→ Imipenem Broadest spectrum, often

synthesis Carbapenems Meropenem used 1st and for mixed infec-
tions, can lower seizure
threshold

Blocks cell wall Glycopeptide Vancomycin Gram + only

synthesis MRSA
No cross between PO and IV
Nephro/ototoxicity
Red man’s syndrome (they
feel allergy but aren’t: prob b/c
of rate of infusion)
Dosed via pharmakinetics
PO: CAN’T be used to treat sys-
temic infections (MRSA)
 Drug Action Category Name Notes

Protein Synthesis Aminoglycosides Gentamicin Nephro/ototoxicity esp. with vancomycin

inhibitors Tobramycin Gram – bacteria (Pseudomonas)
Don’t mix w/ PCN in IV

Protein Synthesis Tetracycline’s Doxycycline Gram +/-, atypical pathogens

inhibitors Minocycline Acne, respiratory, lymes, STDs,
Photosensitivity, teeth straining, bone
growth retardation,
Oral absorption effected by milk/antacids
No children/pregnancies

Protein Synthesis Macrolides Erythromycin Gram +/-, atypical pathogens

inhibitors Azithromycin (Z-pack) Respiratory, STDs, Chlamydia, MAC infec-
tions (AIDS)
MAJOR GI UPSET
CYP450 inhibitor

Protein Synthesis Clindamycin Gram +, Anaerobes

inhibitors Cellulitis w/ PCN allergies
TSS
Osteomyelitis- bone penetration
s/s GI , C. diff

Protein Synthesis Inhibitors: bind to either 30S or 50S ribosomal unit and interfere with tran-
scription of mRNA into protein

Drug Action Category Name Notes

Disrupts DNA Nitromidazoles Metronidazole Gram +/- anaerobes only

structure- CIDAL (Flagyl) Treats C. diff
Major reaction with alcohol

Inhibit DNA tran- TB drugs Rifampin Red discoloration of bodily fluids, hepa-
scription in mRNA totoxic, GI side effects
and protein Inducer of CYP450
Isoianzid (INH) Hepatotoxic, peripheral neuropathy (pre-
vented with vitamin B6)
Inhibit DNA syn- Fluroquinolones Ciprofloxacin (“older”: Pneumonia, UTI, great bone penetration,
thesis by inhibit- (FQ’s) (most over- better gram-(-) coverage, traveler’s diarrhea (cipro) Mixed infec-
ing DNA gyrase- used antibiotic in US)weak gram (-) activity) tions (mox)
CIDAL Levofloxacin & S/s GI, hyperglycemia, Achilles tendon
Moxifloxacin (“Newer”: rupture, Prolonged QT
enhanced gram-(+) activity
& anaerobes) Caution with kids (CF pts. use)
CYP450 inhibitor
 Elderly do not tolerate well

Block incorpora- Sulfas TMP-SMX Gram +/-

tion of PABA sulfadiazine Inflammatory bowel disease, UTI, acute
otitis media, some MRSA
S/S rash/GI
Photosensitivity, increase fluid intake

Anti-Viral Agents
Drug Action Category Name Notes

Inhibit viral DNA Agents for Herpes Acyclovir (Zovirax) Poor bioavailability; given up to q5
replication

Famciclovir (Famvir) Improved bioavailability; given BID to TID

Inhibit DNA syn- Agents for CMV Ganciclovir (Cy- PO availability low; also given IV
thesis by inhibit- (cytomegalovirus) tovene) Biggest issue: bone marrow suppression
ing DNA gyrase-
CIDAL
 Inhibits activity of Anti-flu Tamiflu
enzyme

Inhibits enzyme Anti-retroviral Zidovudine Used for treatment of HIV/AIDS infection

that synthesizes -1st U.S. gov’t approved treatment for HIV
HIV DNA (thus
preventing viral
DNA from form-
ing)

Anti-Fungal Agents
Drug Action Category Name Notes

Forms tube in cell Amphotericin B Used IV for systemic fungal infections

membrane that (Amphotericin A doesn’t do shit for fungal in-
drains ions fections)

Interferes with Ketoconazole

fungal synthesis Used PO to treat fungal infections (i.e.
tinea) and dandruff
Ketoconazole has been used as a treat-
ment for androgen-dependent prostate
cancer

Exam 2

Cardiovascular Drugs
Drug Name Class/precautions How does it work? Uses and S/S

Beta blockers Block effects of SNS by Uses: HTN, angina, ar-

Atenolol (Tenormin)
Metoprolol (Lopressor,
Toprol XL)
Propranolol (Inderal)
-selective binding to beta receptor rhythmias, AMI core
-selective measure, CHF, Migraine
-nonselective B1- lowers HR, contractil- prophylaxis, performance
ity, lowers renin release anxiety
B2- bronchoconstriction **selective for respiratory
diseases
S/S low HR/BP, dysrhyth-
mias (affecting conduc-
tion); AV block, impo-
tence
Precautions: may mask
symptoms of hypoglyce-
mia, must taper,
Spironolactone [Aldac- Aldosterone Block receptors for Uses: HTN, HF
tone] Antagonists aldosterone S/S: Hyperkalemia [care-
– nonselective synthetic Potassium Sparing Diu- ful with salt substitutes]
steroid; also binds some retic – Gynecomastia, hir-
androgen receptors sutism [spironolactone]
someone who gets this is
Eplerenone [Inspra] started on an ACE or
– selective some other drugs and is
looking to get more of a
hormonal blockade

Enalapril (Vasotec) ACE inhibitors -Suppress RAAS Uses:

IV -precautions with bilat-
eral renal artery stenosis,
pregnancy
Ramipril (Altace)
-less effective with Afri-
HF can Americans
-monitor BP, SCr, K+
Captopril (Capoten) -ACE escape
Not a prodrug
Shortest half life
- blocks conversion of An-
giotensin 1 to 2 (2 is a
vasoconstrictor)
-blocks degradation of
bradykinin (dilator)->
causes angioedema
-reduces systemic vascu-
lar resistance- HTN
-prevents renal failure in
diabetics( diabetic neu-
ropathy)
-prevents vascular re-
modeling (MI, AMI core
measure)
-prevents progression of
heart failure (CHF, core
measure)
S/S--dizziness, orthos-
tatic hypertension, GI dis-
tress, nonproductive
cough, headache, hyper-
kalemia (potassium in-
versely related to aldoste-
rone)
-all excreted by kidney
-prodrugs: convert to ac-
tive form in liver
-reduced absorption with
food except enalapril

Losartan (Cozaar) ARBS Blocks the effects of angi- Uses: HTN, CHF, Diabetic
HF startans otensin II by preventing nephropathy, MI
binding to receptors S/S: hypotension, acute
Valsartan (Diovan) renal failure in B/L
RAS(renal), fetal injury

Clonidine (Catapres) Alpha 2- agonist Act within the brainstem Uses: HTN (methyldopa),
lowers CO to suppress sympathetic chronic pain, menopausal
outflow to the heart and symptoms, withdrawal
Methyldopa (Aldomet) blood vessels: vasodila- from opioids
(HTN in Pregnancy) tion, S/S dry mouth, sedation,
HTN/vasodilates low BP, rebound HTN,
Hepatic injury slow taper Positive
Coombs’ test and hemo-
lytic anemia
Terazosin (Hytrin)
Adrenergic Drugs
Tamsulosin (Flomax)
(won’t affect BP, not sys-
temic)
Alpha 1 blockers Prevents stimulation of Uses: HTN with BPH, not
a1 receptors on vessels, for HTN alone.
resulting in vasodilation. S/S: orthostatic hypoten-
1. Dilate arteries, veins sion, dizziness/drowsi-
2. Relaxes smooth muscle ness, vivid dreams
in bladder neck and pros- Warn of 1st dose or-
tate. thostasis; admin at bed-
time, slow titration of
doses.
Do not take with Viagra
(increased risk of hypo-
tension)

Nifedipine (Procardia) CC Blockers Prevents Ca++ from en- Uses: HTN, Angina,
(gingival hyperplasia) (Calcium antagonists) tering cell at S/S: reflex tachycardia
Dihydropyridines- pri- 1. vascular smooth mus- Flushing, edema, heach-
Amlodipine (Norvasc) marily vasodilates cle-> vasodilation ache, dizziness, hypoten-
-P450 and Grapefruit sion, gingival hyperplasia
juice (nifedipine)
-Betas
-Dig

Not for use in CHF

Verapamil (Calan, Verela) CC Blockers Prevents Ca++ from en- Uses: HTN, Angina, Ar-
(Constipation) (Calcium antagonists) tering cell at rythmias
non-Dihydropyridines- 1. vascular smooth mus- S/S:
Diltiazem (Cardizem) effect on cardiac conduc- cle-> vasodilation Lowers HR, AV block,
tion 2. heart -> lowers HR (SA Constipation
-P450 and Grapefruit node) and conduction Flushing, edema, heach-
juice (AV node) ache, dizziness, hypoten-
-Betas sion
-Dig OD- Treat w IV Ca
Not for use in CHF

Sodium Nitroprusside Vasodilator ↓BP via vasodilation Uses: HTN emergencies

(Nitropress) Diuretic 394 when administered IV in- (diastolic >120)
fusion. S/S: flushing, profound
Narrow therapeutic index hypotension, H/A, dizzi-
OD- Treat w IV Ca ness, reflex tachycardia
Cyanide poisoning with
prolonged use(>72hrs)
-CNS effects, delirium
-monitor levels of theocy-
anate

Nitroglycerin (Nitro-Bid, Nitrates pg 369-371 Relax vascular smooth Uses: rapid acting- first
Nitrostat) (rapid) Precautions: muscle via stimulation of line for acute attacks, to
Drug allergy intracellular GMP treat stable, unstable vas-
Isosorbide mononitrate Severe anemia 1. reduce myocardial de- ospastic angina
(Imdur) Closed angle glaucoma mand by decreasing pre-
Hypotension and load Long acting- maintenance
Nitrodur patches Severe head injury Effects: Major dilation of or prevention of angina
(long) venous bed
Deaths reported w drug 1. ↓ work on heart SS: Headache tachycar-
interactions of meds for 2. does NOT affect cardiac dia(REFLEX TACHYCAR-
erectile dysfunction function DIA) postural hypoten-
sion
Topical- contact derititis
 Digoxin-BAD DRUG
Milrinone (Primacor)
Anticoagulants
Name
Heparin
Intrinsic overdose treat-
ing with protamine sul-
fate
Enoxaparin (Lovenox)-
LMWH
Warfarin (coumidin)
-vitamin K antidote
promotes synthesis of
factors only for INR over
5, can develop resistance
if vitamin K is still in sys-
tem
Cardiac Glycosides
Mechanical and electrical
effects on the heart
Positive inotrope- im-
prove force of contraction
Negative chronotrope-
decreases conductivity
No class
Class
Anticoagulant- prevents
or retards formulation of
new thrombi
Anticoagulant- prevents
or retards formulation of
new thrombi
Anticoagulant- prevents
or retards formulation of
new thrombi
-Does not provide instant
protection 2-3 days of
heparin needed in addi-
tion if treating DVT
-blocks vitamin K binding
sites and inhibits synthe-
sis of vitamin K depend-
ent factors and proteins
CNS
Teratogenic- cross BBB
Inhibits sodium potas- Uses: Arrhythmias, CHF
sium pump resulting in S/S GI symptoms (first
increased calcium accu- sign), arrhythmias, head-
mulation ache, yellow halo,
blurred vision
Predisposing factors to
cardiac toxicity: hypoka-
lemia (diuretics),
Heart disease, elevated
digoxin levels
Target level 0.7-1.2
Do EKG for toxicity pts
Antidote- digibind
Phosphodieesterase in- Uses: short term for pts
hibitor acts as a cardio- who have decompensated
tonic or inotropic agent these pts are waiting for
heart transplants etc
– Blocking phos- on these drugs bc we
have nothing left
phodiesterase enzyme ↑
calcium in cells, leading S/S ventricular arrhyth-
mias, hypotension, GI
to stronger contraction
Really only use in last
in cardiac muscle stage of HF
Precautions/monitor S/S
PTT/CBC with platelets- Hematuria, GI bleeding,
only IV (link between hemoptysis, thrombocy-
long term therapy and os- topenia (loewplatlets)
teoporosis
No test for monitoring, Hematuria, GI bleeding,
only given sub-q, pre- hemoptysis, thrombocy-
measured doses topenia less likely than
heparin
INR Minor bruising or bleed-
-maintain fixed intake of ing, nasal mucosal, major
vitamin K GI bleeding, hematuria,
-extensive interaction teratogenic!
with P450 system
 Streptokinase Thrombolytic: DISSOLVE
blood clot at site of injury
by activating plasmino-
gen to plasmin which di-
gests the clot and coagu-
lation factors.
Aspirin Antiplatelets- prevents
platelet aggregation by
inhibiting cyclooxygenase
in platelets
Plavix Antiplatelets- prevents
platelet aggregation by
inhibiting binding of ADP
to platelet receptor, used
if allergy to ASA
-needs to be activated by
TC19 enzyme
Dyslipidemia Agents/Cholesterol/Triglycerides
Name Class
Niacin Niacin
(Niaspan-SR) Acts on hormone sensi-
tive lipase that leads to
inhibition of free fatty
acids from adipose tis-
sue
Ezetimibe (Zetia) Selective Cholesterol
(Prince) Absorption Inhibitors
Selectively inhibits ab-
sorptions of cholesterol
from dietary and biliary
sources
Not to be used if brain in-
jury or hemorrhage, or
with uncontrolled HTN.
Must be given 3-6 hrs of
symptoms. Intracerebral
hemorrhage is a MAJOR
complicatin.
How does it work?
Primary effect ⇑ HDLs
and ⇓ TG
Primary focus is to in-
crease HDL
⇓ LDL/TG
⇑ HDL used as monother-
apy or in combination
with statins (up to 50%
reduction in LDL)
Uses: Acute MI, PE, is-
chemic cardiovascular
events.
Door to needle time
30mins
Uses: prevent stroke, MI,
CV death
S/S dose/duration re-
lated, GI disturbances,
bleeding, discontinue
prior to procedures
Uses: prevent stroke, MI,
CV death
S/S dose/duration re-
lated, GI disturbances,
bleeding, discontinue
prior to procedures
S/S and uses
S/S facial flushing
(blunted with ASA admin-
istration, slow dose titra-
tion, tolerance over time),
GI
Precautions: liver tox-
icity, impairs glucose tol-
erance, increases uric
acid levels, increased risk
of rhabdomylysis when
used with statins
S/S headache, diarrhea
Precautions: check LFTs
(liver function test) if in
combo w statins
 Colestipol (Colestid) Bile Acid Sequestrants
Anion-exchange resins
bind to bile acids in intes-
tinal lumen, form insolu-
ble complexes, allow for
increased secretion of
bile acids, not systemi-
cally absorbed
Fenofibrate (Tricor) Fibric Acid Derivatives
Gemfibrozil (Lopid) Precise mechanism un-
known
lower triglycerides and
boost HDL
for the families that
have hypertriglycer-
idemia
Atorvastatin [Lipitor] HMG-CoA Reductase In-
(most effective) hibitors (statins)
Inhibit enzymes neces-
Simvastatin [Zocor] sary for precursor of cho-
lesterol – ONLY DRUGS
Pravastatin [Pravachol] THAT DIRECTLY WORK
(not metabolized by ON THE CHOLESTERAL
CYP450, used by pts PATHWAY
with transplants/HIV) -block that enzyme that
prevents the conversion
to Mevalonate- cutting
out the cholesterol path-
way
Isosorbide mononitrate Nitrates (NTG)
[Imdur] Relax vascular smooth
– longest acting PO muscle via stimulation of
agent, once daily intracellular GMP
Transdermal [NitroDur] – Reduce myocardial de-
mand by decreasing pre-
load LONG ACTING
Maintenance or preven-
tion of future anginal at-
tacks
Dysrhythmic Agents
Name Class & Precautions
LEAST EFFECTIVE Uses: more cholesterol
circulating for conversion
– More cholesterol circu- to bile acids, increased ca-
lating for conversion to tabolism of LDL by liver
S/S bloating, constipa-
bile acids
tion, nausea precautions:
– Increased catabolism interferes with other
of LDL by live drugs- by binding with
them
administer 1 hr before
or 3-4 hrs after
TG concentrations S/S dyspepsia, Hepato-
⇑ HDL toxicity
minimal effect on LDL Monitor LFTs
Increases risk rhabdomy-
olysis when used with
statin
⇓ LDL/TG NO GRAPEFRUIT JUICE!
⇑ HDL S/S GI headache, photo-
primary focus is LDL sensitivity
Monitor LFTs, serum Cr,
CPK
Precautions: myopathy,
and rhabdo, restricted to
80mg due to risk
Hepatoxicity –
Contraindicated in active
liver disease
Take in the evening
Effects: Major dilation of S/S Postural hypotension,
venous bed headache, dizziness, re-
– Decrease work on heart flex tachycardia, cutane-
– Does not affect cardiac ous vasodilation with
function (HR or contracti- flushing
bility)
Precautions:
– Tolerance (need nitrate-
free period) -NITRODUR
– Withdrawal when ab-
rupt discontinuation
• Rebound HTN and an-
gina
– Do not carry close to
body; keep in cool place
– Drug interactions (other
dilators…)
How Does it work S/E and Uses

Quinidine
Procainamide
SLE syndrome
Lidocaine
Flecainide [Tambocor]
Propafenone
PO Agent
Used for ventricular ar-
rhythmias or paroxysmal
atrial tachycardia
BAD DRUGS
Propranolol [Inderal]
Non-selective
PO Treatment of HTN, an-
gina, migraine prophylaxis
(MOST COMMON)
Esmolol [Brevibloc]
Selective
IV agent with short t1/2 Im-
mediate control of SVTs and
tachycardia
Acebutolol [Sectral]
Selective
PO agent; Treatment of HTN
and PVCs
Amiodarone
PO, IV for atrial/ventr ar-
rhythmias Drug of choice
Class Ia Work Block Na+ channels in
cell membrane during action
potential
Proteinbound - Affect Phase 0 during the
Drug interaction with digoxin Action Potential-Blocks the
[displaces digoxin from albu- Na channels
min]
Strongly anticholinergic
(blocks inhibit parasympatic
NS);
↑ ventr rate [pretreat with BB
or CCB]
– Widens QRS and prolongs
QT
Class Ib Agent Work Block Na+ channels in
cell membrane during action
potential
Affect Phase 0 during the
Action Potential- Blocks the
Na channels
Differs from Ia [accelerates
repolarization]
Class Ic Work Block Na+ channels in
cell membrane during action
Generally not used in current potential
clinical practice due to CAST - Affect Phase 0 during the
data and better agents Action Potential- Blocks the
Na channels
Beta Blocker ↓ automaticity at SA node
Class II
↓ conduction velocity at AV
Cautions: node
– Pre-existing bradycardia – ↓ contractility
CHF, asthma, COPD
Affects Phase 4 of the Action
Potential-decreases spontane-
ous depolarization
Class III Block K+ channels; prolong
phase 3; prolong repolariza-
tion
Uses: Afib, premature atrial
contractions, premature ven-
tricular contractions, ventric-
ular tachycardia and Wolf-
Parkinson-White Syndrome
S/E: Hypotension,
QRS > 50% prolongation,
GI symptoms, Cinchonism
blurred vision, tinnitus
Albumin bound- not good w
dig
Prototype SE
Not seen a lot due to bone
marrow suppression
Uses: Ventricular dysrhyth-
mias only(premature ventric-
ular contractions, ventricular
tachycardia, Vfib)
Short term IV for ventricu-
lar arrhythmia
SE Metallic taste, slurred
speech, Convulsions CNS
effects (Agitation, Anxiety,
Seizures)
Little or no effect on EKG
Uses: Severe ventricular
tachycardia and supra-
ventricular tachycardia
dysrhythmias, Afib and flut-
ter and Wolf-Parkinson-
White Syndrome
ventricular arrhythmias or
paroxysmal atrial tachy-
cardia
SE: ↑ risk of death
Uses: Treatment of SVTs
and PVCs [supraventricular
tachycardias; premature ven-
tricular contractions]
SE CNS [dizziness, drowsi-
ness]
– CV [↓ BP, ↓ HR]
Uses: Life Threatening
Ventricular tachycardia of fi-
brillation
(afib emg) for ACLS treat-
ment of ventricular arrhyth-
mia
Dofetilide [Tikosyn]
PO Conversion of Afib to
NSR; maintenance of NSR Cr
Cl calculation important-need
to be supervised while treated
Ibutilide [Corvert]
IV Rapid conversion of Afib
of recent onset < 90 days-
need to be supervised while
treated
Bretylium IM,
IV Short-term treatment of
ventricular arrhythmias when
others fail
Diltiazem
Verapamil
Adenosine
Diuretics
Name
Hydrochlorothiazide
(HCTZ) (HydroDiuri)
Chlorthalidone
(Hygroton)
Cautions: – When used in
presence of hypotension or
shock – Prolong QT interval
– CYP450 3A4 interactions
with amiodarone; t1/2
amiodarone 25 -110 days
Class IV
Ca Channel Blockers
Non-Dihydropyridines
Cautions: digoxin, BB
Other
Class
Thiazide Diuretics
(belong to chemical class
sulfonamides)
Precautions:
Don’t use if pregnant.
⇑ risk of digoxin toxicity
(b/c of K levels).
DM and gout
Caution in pt w/ DM,
gout or sulfa allergy.
How they work: Block Ca++
channels in cell membrane
↓ automaticity at SA node
↓ conduction velocity at AV
node – ↓ contractility •
How it works:
↓ automaticity at SA node
↓ conduction velocity at AV
node
How does it work?
Block chloride pump in
early distal convoluted
tubule.
⇓ Na, Cl, K and minor loss
in water.
⇑ levels of uric acid and
glucose
*Small dosage range
SE:
-Prolonged OT interval
-Hypotension, CHF – GI
– Pulmonary toxicity, skin
discoloration (BLUE), thy-
roid [amiodarone]
Uses: to slow ventr rate in
Afib or terminate SVTs •
SE: ↓ BP, ↓ HR, constipa-
tion, AV block
Uses: Treatment of paroxys-
mal SVTs or WPW syn-
drome
• T1/2 1.5 to 10 secs….ad-
ministered IV bolus as close
to the heart as possible
SE flushing, dyspnea, hypo-
tension
S/S and uses
Uses: Mild diuretics. Uncom-
plicated HTN.
S/S:
Hypotension & dehydra-
tion
-dizziness, lightheadedness
Hypokalemia
- watch for weakness, muscle
cramps, arrhythmias – rare
at doses use
Hyponatremia (watch w/pt
on lithium)
Hyperglycemia. And gout (at
higher doses)
Acetazolamide (Diamox) Carbonic anhydrase in- Work to block formation Uses: Mild diuretics used
hibitors of carbonic acid and bi- most often to treat glau-
carbonate in renal tubule coma
– Not used clinically to treat
Cautions: – Inhibit enzyme, car- HTN or edema
– Patients with sulfa al- bonic anhydrase, results
lerg in decreased secretion of S/S
aqueous humor of eye metabolic acidosis [loss of
bicarb];
– Also slow down move- hypokalemia
ment of hydrogen so
more sodium and bicar-
bonate are lost in urine

Furosemide Loop Diuretics Work in loop of Henle. Uses: Acute PE, CHF and
(Lasix) Large loss of water, Na edema.
Precautions and K. Most potent diu- Esp useful in pts w/ renal
Bumetanide -Take in the morning retic. failure.
(Bumex)
-Monitor bp, *very large dosage range S/S:
Hypotension
-Caution for postural Most potent diuretic used -dizziness, lightheadeness
hypotension. in ACUTE SETTINGS Dehydration
-dry mouth, scanty urine
-Consume K rich foods. output
Hypokalemia,
Ototoxicity (increase risk
if pt on aminoglycoside(an-
tibiotics))
Hyperglycemia is not com-
mon.
 Triamterene (Dyrenium) Potassium-sparing Diu-
( Acts more quickly. retics
Non aldosterone antagonist (Aldosterone Inhibiting)
Direct decrease in ion
transport,
Uses:HTN, edema)
Spironolactone
(Aldactone)
(More chronic use-slower
onset- 48hrs.
Aldosterone antagonist
Affects ions by blocking ac-
tion of aldosterone in distal
nephron
Uses: HTN, Heart failure,
edema, primary hyperal-
dosteronism)
Mannitol (Osmitrol)
Anemias
Drug name
Darbepoetin (Aranesp)
*Long acting
Epoetin (Procrit, Epogen)
Osmotic Diuretics
Precautions:
Hypersensitivity
Anuria
Severe dyhydration
Pulmonary congestion
Cerebral hemmhage
May crystalize when ex-
posed to low temps
-should always be admin-
istered IV through a filter
-vials stored in warmer
pharmacy
-B4 administration vial
should be inspected for
precipitants
Class & how it works
Recombinant hormone:
Stimulate production of
RBC’s in bone marrow.
Goal of drug is to get Hgb
12g/dL.
Act to spare K in ex-
change for loss of Na and
water in urine.
Used in combination
with thiazides or loops
– Rarely used alone b/c
limited diuresis
– Corrects K+ loss of
other diuretics
FYI: never combine w/K
supplements, ACEi, or
other K sparring diuretics.
Use hypertonic pull to re-
move fluid from intravas-
cular spaces and deliver
large amounts of fluid
into renal tubule.
Drug is highly controlled
usually in ICU settings.
What it is used for
Anemia associated with
CKD. Administered SC or
IV.
Is abused and used to
raise RBCs higher than
needed to prevent fa-
tigue
Uses: HTN, edema, (Spirono-
lactone is also used for HF
and primary hyperaldoste-
ronism.)
-Preferred if K loss is dan-
gerous (digoxin or arrhyth-
mias).
Rarely used alone b/c lim-
ited dieresis. Used with thia-
zides or loops b/c it corrects
their loss of K.
S/S: Hyperkamemia,
gynecomastia, hirsutism
(spironolactone),
blue urine(Triamterene)
Uses:
(IV) Decrease ICP, prevent
renal failure, decrease intra-
ocular pressure, and pro-
mote movement of toxic sub-
stance through kidney. Drug
intoxication (to induce diu-
resis)
S/S: sudden drop in fluid lev-
els, hypotension, electrolyte
imbalances.
S/S and precautions
Pts should receive iron sup-
plements. May take 6 weeks
to see effects. Used to re-
duce need for transfusion
only.
S/S: Hypertension, head-
ache, edema, fatigue, HF, ar-
rhythmias.
IN NEWS: if abused may
cause blood clots and spur
tumor growth!
 Ferrous sulfate Iron Salt: Iron enters
bloodstream and is trans-
ported to liver, spleen,
bone marrow where it be-
comes part of iron stores.
Treatment of iron defi- S/S: GI (constipation, black
ciency in anemia feces)- titrate up to goal
dose to build up tolerance.
Take w/stool softener. Can
take with food but will ↓ bi-
oavailability.
IV: Associated w severe Hy-
persentivity reactions
Interactions:
-antibiotics ↓ absorption
-↓ acidic environment
↓ absorption
-Vitamin C ↑ absorption

Cyanocobalamin (Nasco- Water soluble vitamin:
bal) (Vitamin B) Available as nasal gel given
once weekly and 100mcg
IM/SC for 1 week then ti-
trated to monthly.
Vitamin B12 deficiency. Clinical improvement is in-
Used when deficiency is creased alertness, appetite
due to malabsorption. and cooperation. Hct in-
creases within 2 months.
Lifelong therapy.

CV III
Drug Name Class & Precautions
Heparin Anticoagulants
Unfractionated, Conventional
(large molecule)
Precautions:
-Monitor aPTT [IV therapy]
Treatment of od/excess
-Monitor CBC with plate-
with protamine sulfate
lets (thrombocytopenia)
[IV therapy] – Long-term
therapy and osteoporosis
How it works
Binds to antithrombin III
and inactivates a number
of factors (see slide)
– Inactivates intrinsic path-
way
– Inhibits conversion of
prothrombin to thrombin
and fibrinogen to fibrin
Uses and SE
USES:
Stroke, MI, DVT, PE, LV
thrombus (AFib)
-Prevents or retards for-
mation of new thrombi
-Prevents worsening of
thrombi damage
-allows almost instantane-
ous action
-SQ-Trying to prevent
clots
-IV- treating a clot
SE: Hematuria, GI bleed-
ing, hemoptysis Thrombo-
cytopenia

Low-molecular weight hepa- Anticoagulants Products vary based on USES:

rins (LMWH)
Enoxaparin (lovenox)
Smaller molecule
Warfarin [Coumadin]
Vitamin K is the antidote
When INR >5
Not for and acute situa-
tions
size, anti-Xa activity, in- Surgery prophylaxis, DVTs,
Monitoring: dications and dosage regi- PE
– Routine aPTT not neces- mens
sary – NOT considered thera- SE:
– CBC with platelets peri- peutically interchangeable Same as UFH but >likely
odically – Enoxaparin (lovenox) – Hematuria, GI bleeding,
has been most widely used hemoptysis
-Check factor 10 A – Hemorrhage, thrombo-
cytopeni
Oral anticoagulants Blocks vitamin K-binding USES:
The only one in the US sites and inhibits synthe- Prevent extension of existing
sis of vitamin K-depend- thrombus and formation of
ent factors (2, 7, 9, 10) and new thrombi
Precautions
proteins C and S

Vitamin K (pg)
Phytonadione
(Vitmain K1)
Aquamephyton
(Vitmain K1)
Alteplase (Activase)
ASA (Aspirin)
Prevents platelet aggregation
by inhibiting cyclooxygenase
in platelets, preventing syn-
thesis of TXA2 and prostacy-
clin
Agent of choice to prevent
thromboembolic events
Clopidogrel (Plavix)
Inhibits platelet aggregation
by inhibiting the binding of
ADP to platelet receptor
– Narrow therapeutic index
drug
– Monitor INR (goal deter- levels [general goal is 2-3]
mined by indication for use)
and CBC with platelets
– Maintain fixed intake of
Vitamin K [avoid binging on
green, leafy vegetables]
– EXTENSIVE drug interac-
tions with P450
– Discontinuation prior to
procedure
-DO NOT USE WHILE PREG-
NANT
Vitamin
Thrombolytic agents Dissolve blood clots at site
Precautions: – Activate plasminogen to
– Not to be used if brain
injury or hemorrhage, un-
controlled HTN
– Must be administered
within 3-6 hrs of onset of
stroke symptoms
– Intracerebral hemor-
rhage is major complica-
tion
Antiplatelet agents Block formation of blood
Precautions:
– GI bleeding with
clopidogrel [plavix],
NSAIDs, warfarin, steroids
– Need to discontinue
prior to procedures…
-takes 72 hr for onset of ac-
– Dosage adjusted by INR tion
– Will NOT affect existing
clotting factors
– Stops production of NEW
clotting factors ONLY
– Given PO once daily [long
half-life]
SE:
Minor bruising or bleeding is
common [oral, nasal mucosa]
– Major bleeding (GI, hema-
turia, hemoptysis) – Terato-
genic!
Promotes synthesis of USES:
clotting factors 2, 7, 9, Reversal of bleeding due
10 to warfarin overdose
-PO dose depends upon
INR level (>5)
SE:
Difficult to overcome “re-
sistance” after large doses
of Vit K administered
-making it hard to reiniti-
ate warfarin therapy
USES:
of intravascular injury Acute MI, pulmonary em-
bolism, ischemic cardio-
plasmin vascular events
– Plasmin digests clots
and coagulation factors SE:
-Don’t use while pregnant
-Internal, superficial, intra
cranial bleeding
USES:
clots by preventing Prevention of stroke, MI,
platelet clumping CV death
SE:
Dose-related and duration-
related – Gastrointestinal
disturbances [nausea, dys-
pepsia, heartburn] –
Bleeding
 -Used if allergy to ASA or in-
tolerance to ASA or in combi-
nation with ASA for certain
CV indications

Prasugrel (Effient)
ADP receptor antagonist just
like Plavix Advantages?: Less
genetic polymorphism issues
than Plavix
Protamine sulfate Reverses heparin OD

Start EX 3

Diabetes mellitus

Drug Name Class Works on S/S notes

Glyburide Sulfonureas Pancreas Hypoglycemia, Take 30 min prior to
(Micronase) weight gain, GI, meal
photosensitivity,

Glipizide Sulfonureas pancreas Hypoglycemia, Take 30 min prior to

(Glucotrol) weight gain, GI, meal
photosensitivity,

Metformin Metformin Liver, skeletal mus- GI (titrate up), Contraindications: se-

(Glucophage) cles- NO INSULIN SE- taste, Lactic acido- rum creatinine:
CRETION sis greater than 1.4 f or
1.5 m, liver disease,
alcoholic, hx of LA,
HF, stop prior to pro-
cedure with contrast
Rosiglitazone (Avandia) thiazolidinedi- Liver, skeletal mus- Hepatic fail- Recent press: Avandia
ones cles, adipose tissue ure/death (Avan- is increased CV risk-
Pioglitazone (Actos) “insulin sensitizers” dia), GI, BMS, similar effects of con-
weight gain (less trol versus rosi group
than SFUs), edema,
CHF

Repaglinide Meglitinides Pancreas- Similar to Hypoglycemia,

sulfonylureas but H/a, upper resp in-
shorter acting fections

Acarbose Alpha-gluco- Delays breakdown of GI- ‘life changing’ Take with first bite of
(precose) sidase inhibi- ingested carbs, reduc- FLATULENCE, meal, do not eat=do
tor ing post prandial hy- hepatotoxicity- not take med
perglycemia baseline LFTs

Repaglinide (Prandin) Meglitinides – Similar to sulfonylu- – Hypoglycemia For pts that the SFU
reas but shorter act- [less so than SFUs] hypoglycemia was
ing – Headache too pronounced.
– Increase insulin re- – Upper respira-
lease from pancreas tory infections Still possibility of
weight gain less pro-
nounced

Exenatide [Byetta] GLP-1 ana- Binds to GLP-1 recep- Minimal Hypogly- Administered SC BID
logue tors which increases cemia, Nausea, mi- prior to meal
glucose dependent nor weigh loss
(new agent for insulin secretion; in- BLACK BOX-
type ii) hibits appetite and PANCRETITIS
stimulates release of -no real proof
insulin when glucose
levels become too
high
Sitagliptin DPP-IV Inhibi- Competitive-reversi- – Hypoglycemia Increases chance of
(Januvia) tors, the ble inhibitor of DPP- weight loss
[minimal]
“Gliptins IV (increases GLP-1)
– Increase glucose de- – Nausea Diarrhea Pancreatitis or thy-
pendent insulin secre- – ↑ risk of infec- roid cancer
tion tion?
– Moderate glucagon
– Caution in renal
secretion
insufficiency
 – Delay gastric empty- – New black box
ing
warning [pancrea-
– Reduce food intake
titis]

Octreotide Pituitary Impairs gallbladder Enhances effects of Caution in renal im-

(Sandostatin) Drugs function prolong QTc inter- pairment
Somatostatin Effects glucose regu- val
lation in HYPOglyce-
mic type I and may
cause HYPERglycemia
in ot w type ii or w/o
diabeties

Adrenal disease
Drug Name Classification How it works SE Precautions
Desmopression Pituitary drugs Artificial ADH hormone – Drowsiness, diz- • Major complica-
[DDAVP] used to suppress affect- ziness, headache tion
ing the posterior pitui- – GI [stimulation – hyponatremia
tary. Reducing water of GI motility] – Occurs if exces-
excretion – Local nasal irrita- sive fluid intake
tion – Check serum so-
Also used for nocturnal dium regularly
enuresis

Prednisone Glucocorticoids • Block inflammatory Associated with – In presence of in-

(Deltasone) mediators and anti- systemic admin- fection
-longer duration body formation in im- istration – Diabetes
-preferred mune system – Fluid retention, --bc it effect glu-
-used in combo to weight gain, in- cose tolerance
treat Addison’s dis- Can be used to treat somnia, glucose in-
ease chronic asthma & bron- tolerance, mood
chitis changes, growth
Methylpredniso- retardation
lone [Medrol]
Fludrocortisone Mineralocorti- Stimulate retention of Side effects: • Cautions: severe
[Florinef] coids sodium and water and – Fluid retention, HTN, heart failure
excretion of potassium edema, HTN,
• Uses: treating ad- hypokalemia
renal insufficiency; or-
thostatic hypotension
 Thyroid disease

Drug Name Classification How it Works/ SE Cautions

Uses
Methimazole Antithyroid drugs Block production – Lethargy, brady- – Bone marrow sup-
[Tapazole] of thyroid hor- cardia] pression
-once daily admin- Hyperthyroidism mones by inhibit-
istration ing enzyme thyrop-
eroxidase

Propylthiouracil Antithyroid Block production – Lethargy, brady- – GI [more so with PTU

[PTU] of thyroid hor- cardia]
-q8h administra- Hyperthyroidism mones by inhibit-
tion ing enzyme thyrop-
eroxidase

Also inhibit con-

version of T4 to T3
Levothyroxine Thyroid Replace- Replace thyroid – Nervousness, Has MANY drug inter-
[Synthroid] ment Drugs hormones not be- tremors actions
T4 salt; preferred ing produced – Insomnia -take on an empty
due to predictable Hypothyroidism – Arrhythmias, HTN stomach
bioavailability – Nausea, vomiting -separate from other
– Diaphoresis meds like iron, antac-
– Weight loss ids, and vitamins.
Indicate drug has -Take in the morning,
been titrated too separated from every-
much thing else.
-Take every day and
do not skip doses.
Atenolol Beta Blocker Used to prevent Nonselective beta Avoid sudden with-
heart attacks and blockers blunt sys of draw
treat HTN and an- hypoglysemia
gina May delay recovery
from hypoglycemia for
pts w Type I