ABLE 4 Final MoAs

Albuterol

selective β₂-adrenergic agonist that acts on β₂-adrenergic receptors of intracellular adenylyl cyclase to increase cyclic AMP levels, resulting in bronchial smooth muscle relaxation.

Amlodipine

long-acting dihydropyridine calcium-channel-blocking drug with potent arterial and coronary vasodilating properties.

Atenolol

cardioselective β-adrenergic that decreases AV nodal conduction in supraventricular tachycardias and blockade of catecholamine-induced dysrhythmias.

Atorvastatin

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis

Amiodarone

ype III antiarrhythmic that prolongs the effective refractory period of atrial and ventricular tissue by blocking potassium conductance.

Apixaban

selective inhibitor of factor Xa, decreases thrombin generation and thrombus development

Azelastine

selective H₁-receptor antagonist that blocks release of histamine from cells involved in the allergic response. It also inhibits other mediators of allergic reactions (eg, leukotrienes, etc), and reduces chemotaxis and eosinophil activation.

Benazepril

competitive ACE-I. It also reduces serum aldosterone and inhibits the tissue renin-angiotensin system.

Bisoprolol

cardioselective β-adrenergic blocker that decreases AV nodal conduction in supraventricular tachycardia and blockade of catecholamine-induced dysrhythmias. The antihypertensive mechanism is unknown

Budesonide

anti-inflammatory with potent glucocorticoid and weak mineralocorticoid activity. It exhibits a broad range of active inhibition against multiple cell types and mediators involving allergic and nonallergic/irritant-mediated inflammation.

Budesonide/Formoterol

anti-inflammatory with potent glucocorticoid and weak mineralocorticoid activity plus a long-acting selective β₂-adrenergic agonist that produces bronchodilation

Candesartan

selective, reversible, competitive antagonist of the angiotensin II receptor type 1

Carvedilol

selective α₁- and nonselective β-adrenergic blocker that decreases AV nodal conduction in supraventricular tachycardias and blockade of catecholamine-induced dysrhythmia

Cetirizine

low-sedating, long-acting, competitive H₁-receptor antagonist that is a metabolite of hydroxyzine, prevents the allergic response

Chlorthalidone

increases sodium and chloride excretion by interfering with their reabsorption in the cortical-diluting segment of the nephron.

Clonidine

stimulates presynaptic α₂-adrenergic receptors and blocks postsynaptic α₂-adrenergic receptors in the CNS by activating inhibitory neurons to decrease sympathetic outflow. These actions reduce peripheral vascular resistance, renal vascular resistance, HR, and BP.

Clopidogrel

antiplatelet agent that prevents platelet aggregation by direct inhibition of ADP binding to receptor sites, inhibiting subsequent activation of the glycoprotein IIb/IIIa complex. This action is irreversible

Colesevelam

nonabsorbed, polymeric, lipid-lowering agent that binds intestinal bile acids, resulting in the increased clearance of LDL-cholesterol and a reduction in total cholesterol

Dabigatran

competitive, reversible, direct thrombin inhibitor. prevents the development of a thrombus

Digoxin

exert positive inotropic effects through improved availability of calcium to myocardial contractile elements, thereby increasing cardiac output in heart failure. Antiarrhythmic actions are caused primarily by an increase in AV nodal refractory period via increased vagal tone, sympathetic withdrawal, and direct mechanisms.

Diltiazem

calcium-channel-blocking drug that decreases HR, prolongs AV nodal conduction, and decreases arteriolar and coronary vascular tone. It also has negative inotropic properties.

Dipyridamole

Inhibits the uptake of adenosine into platelets, endothelial cells, and erythrocytes resulting in an increase in local concentrations of adenosine, which is a coronary vasodilator and a platelet aggregation inhibitor.

Doxazosin

selectively blocks postsynaptic α₁-adrenergic receptors, reducing peripheral resistance through arterial and venous dilations. Reflex tachycardia that occurs with other vasodilators is infrequent because there is no presynaptic α₂-receptor blockade. Increase urine flow by relaxing smooth muscle tone in the bladder neck and prostate.

Edoxaban

selective inhibitor of FXa. decreases thrombin generation and thrombus development.

Enalapril

prodrug that is rapidly converted to its active metabolite, enalaprilat, a competitive ACEI. It reduces serum aldosterone and inhibits the sympathetic nervous system and tissue renin-angiotensin system

Enoxaparin

low-molecular-weight heparin which has anti–factor Xa and IIa properties.

Ezetimibe

localizes at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood

Felodipine

dihydropyridine calcium-channel-blocking drug with potent arterial and coronary vasodilating properties. A reflex increase in sympathetic tone (in response to vasodilation) counteracts the direct depressant effects on SA and AV nodal conduction

Fenofibrate

activate peroxisome proliferator-activated receptor α (PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III

Fexofenadine

antihistamine with selective peripheral H₁-receptor antagonist activity

Fluticasone Nasal

anti-inflammatory, antipruritic, and vasoconstrictive properties. inhibits the release of arachidonic acid by phospholipase A2

Fluticasone Oral Inhaler

corticosteroid with anti-inflammatory effects. It is a human glucocorticoid receptor agonist that inhibits multiple cell types and mediator production or secretion involved in asthma

Fluticasone/Salmeterol

corticosteroid with anti-inflammatory effects. It is a human glucocorticoid receptor agonist that inhibits multiple cell types and mediator production or secretion involved in asthma and COPD plus a long-acting β₂-adrenergic agonist, stimulates intracellular adenylyl cyclase in catalyzing the conversion of adenosine triphosphate (ATP) to cyclic-3',5,'-adenosine monophosphate (cyclic AMP) resulting in the relaxation of bronchial smooth muscle and inhibition of the release of mediators

Fosinopril

competitive ACEI. It also reduces serum aldosterone and inhibits the sympathetic nervous system and the tissue renin–angiotensin system

Furosemide

loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle's loop, where it decreases sodium reabsorption by competing for the chloride site on the Na⁺-K⁺-2Cl^- cotransporter

Gemfibrozil

activate PPAR-α, which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III

Hydralazine

vasodilator that reduces total peripheral resistance by direct action on vascular smooth muscle, with an effect greater on arterioles than on veins

Hydrochlorothiazide

increase sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron

Hydroxyzine

suppresses activity in key locations of the subcortical area of the CNS. Primary skeletal muscle relaxation, bronchodilator activity, antiemetic effects, and antihistaminic and analgesic effects

Ipratropium/Albuterol

a selective β₂-adrenergic agonist that produces bronchodilation, vasodilation, uterine relaxation, skeletal muscle stimulation, peripheral vasodilation, and tachycardia plus a competitive antagonist of acetylcholine at peripheral, but not central, muscarinic receptors that produces bronchodilation

Irbesartan

selective, reversible, competitive antagonist of angiotensin II receptor

Isosorbide Mononitrate

converted to NO by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.

Labetalol

adrenergic receptor blocking drug that has selective α₁- and nonselective β-adrenergic receptor blocking actions.

Levalbuterol

Activation of β₂-adrenergic receptors on airway smooth muscle leads to the activation of adenylate cyclase and an increase in the intracellular concentration of cyclic-3',5'-adenosine monophosphate (cyclic AMP). relaxing the smooth muscles of all airways, from the trachea to the terminal bronchioles.

Levocetirizine

low-sedating, long-acting H₁-receptor antagonist that is a metabolite of hydroxyzine. It competitively inhibits the interaction of histamine with H₁ receptors, thereby preventing the allergic response.

Lisinopril

competitive ACEI. It also reduces serum aldosterone and inhibits the sympathetic nervous system and the tissue renin–angiotensin system

Losartan

selective, reversible, competitive antagonist of the angiotensin II receptor

Lovastatin

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis

Metoprolol

cardioselective β-adrenergic blocker used in arrhythmias, HTN, angina pectoris, and heart failure. It is also effective in decreasing post-MI mortality

Mometasone

anti-inflammatory, antipruritic, and vasoconstrictive properties. inhibits the release of arachidonic acid by phospholipase A2

Montelukast

binds with leukotriene receptors to inhibit physiologic actions of leukotriene.

Nebivolol

long-acting cardioselective β₁-adrenoceptor antagonist without intrinsic sympathomimetic activities

Niacin

Not well defined. May involve partial inhibition of release of free fatty acids from adipose tissue and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma

Nifedipine

calcium ion influx inhibitor that selectively inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle

Nitroglycerin

converted to nitric oxide (NO) by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle

Olmesartan

selective, reversible, competitive antagonist of the angiotensin II receptor

Omega-3-Ethyl Esters

inhibition of acyl-CoA:1,2-diacylglycerol acyltransferase, increased mitochondrial and peroxisomal β-oxidation in the liver, decreased lipogenesis in the liver, and increased plasma lipoprotein lipase activity

Prasugrel

inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y₁₂ class of ADP receptors on platelets.

Pravastatin

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis.

Propranolol

nonselective β-adrenergic blocker that competitively blocks β₁ and β₂ receptors, thereby preventing β-adrenergic stimulation

Quinapril

competitive ACEI. It also reduces serum aldosterone and inhibits the sympathetic nervous system and the tissue renin–angiotensin system

Ramipril

competitive ACEI. It also reduces serum aldosterone and inhibits the sympathetic nervous system and the tissue renin–angiotensin system

Ranolazine

inhibits the late phase of the inward sodium channel during cardiac repolarization reducing intracellular sodium concentrations, thereby reducing calcium influx via Na⁺-Ca²⁺ exchange that in turn reduces ventricular tension and myocardial oxygen consumption

Rivaroxaban

orally bioavailable factor Xa inhibitor that selectively blocks the active site of factor Xa and does not require a cofactor (such as antithrombin III) for activity

Rosuvastatin

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis

Sacubitril/Valsartan

prodrug that inhibits neprilysin through the active metabolite LBQ657, leading to increased levels of peptides, including natriuretic peptides plus a selective, reversible, competitive antagonist of the angiotensin II receptor

Simvastatin

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis

Spironolactone

steroidal competitive aldosterone antagonist that acts from the interstitial side of the distal and collecting tubular epithelium to block sodium-potassium exchange, producing a delayed and mild diuresis

Terazosin

selectively blocks postsynaptic α₁-adrenergic receptors. Total peripheral resistance is reduced through arterial and venous dilations. no presynaptic α₂-receptor blockade

Ticagrelor

reversible and noncompetitive binder of the adenosine diphosphate (ADP) P2Y₁₂ receptor on the platelet surface which prevents ADP-mediated activation of the GPIIb/IIIa receptor complex, thereby reducing platelet aggregation

Tiotropium

long-acting antimuscarinic agent, which is often referred to as an anticholinergic. inhibition of M3-receptors at the smooth muscle leads to bronchodilation

Tolvaptan

selective vasopressin V₂-receptor antagonist with an affinity for the V₂-receptor that is 1.8 times that of native arginine vasopressin (AVP). causes an increase in urine water excretion that results in an increase in free water clearance, a decrease in urine osmolality, resulting in the restoration of normal serum sodium levels

Torsemide

loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle’s loop, where it decreases sodium reabsorption by competing for the chloride site on the Na⁺-K⁺-2Cl^- cotransporter.

Triamterene/Hydrochlorothiazide

acts directly from the distal tubular lumen on active sodium exchange for potassium and hydrogen, producing a mild diuresis that is independent of aldosterone concentration plus a thiazide diuretic that increases sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron

Varenicline

binds with high affinity and selectivity at α4β2 neuronal nicotinic acetylcholine receptors. produces agonist activity, while simultaneously preventing nicotine binding to these receptors

Valsartan

selective, reversible, competitive antagonist of the angiotensin II receptor

Verapamil

Inhibits calcium “slow channels” on vascular smooth muscle and myocardium producing relaxation of muscle and vasodilation. Increases myocardial oxygen delivery and slow conduction through the AV node.

Warfarin

prevents the conversion of vitamin K back to its active form from vitamin K epoxide. This impairs formation of the vitamin K–dependent clotting factors II, VII, IX, and X (prothrombin) and proteins C and S (physiologic anticoagulants).

allopurinol

decreases the production of uric acid by inhibiting the action of xanthine oxidase, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid

alprazolam

Enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA)

amitriptyline

a tricyclic antidepressant that blocks presynaptic reuptake of serotonin and norepinephrine with subsequent downregulation of adrenergic receptors

aripiprazole

an atypical antipsychotic agent (quinolinone derivative). It exhibits partial agonist activity at dopamine D₂ and D₃ receptors and serotonin 5-HT_1A receptors and antagonist activity at 5-HT_2A receptors.

atomoxetine

selective norepinephrine reuptake inhibitor that produces therapeutic effects in patients with ADHD

baclofen

inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by hyperpolarization of afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect

buprenorphine/naloxone

μ-opioid receptor partial agonist and a -opioid receptor antagonist plus μ-opioid receptor antagonist that causes opioid withdrawal when injected parenterally and is included in the formulation to reduce the risk of abuse

bupropion

monocyclic antidepressant, unique as a mild dopamine and norepinephrine uptake inhibitor with no direct effect on serotonin receptors or MAO

carbamazepine

acts presynaptically to block firing of action potentials, which decreases the release of excitatory neurotransmitters, and postsynaptically by blocking high-frequency repetitive discharge initiated at cell bodies

carisoprodol

blocks interneuronal activity in descending reticular formation and spinal cord, resulting in muscle relaxation.

celecoxib

Inhibition of the COX-2 enzyme isoform is thought to be responsible for the anti-inflammatory effects

citalopram

bicyclic antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin (an SSRI)

clobazam

potentiation of neurotransmission resulting from binding at the benzodiazepine site of the GABA_A receptor

clonazepam

Enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA)

codeine

a phenanthrene opioid with very low affinity for opioid receptors. Its analgesic activity appears to result from conversion to morphine

colchicine

Exact mechanism unknown. In patients with gout, may interrupt the cycle of monosodium urate crystal deposition in joint tissues and the resultant inflammatory response that initiates and sustains an acute attack. also inhibits urate crystal deposition

conjugated estrogens

act through binding to nuclear receptors in estrogen-responsive tissues

cyclobenzaprine

relieves skeletal muscle spasm of local origin without interfering with muscle function

desvenlafaxine

potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, α-adrenergic, or histamine receptors

dexmethylphenidate

stimulant that increases CNS activity by inhibiting reuptake of norepinephrine and dopamine, increasing neuronal firing rate, and stimulating the cerebral cortex and subcortical structures

diazepam

Enhanced postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA)

diclofenac

Nonselective inhibitor of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2)