MP 135 Top 50 Drugs

Atorvastatin

Lipitor

statin drug, antihyperlipidemic (HMG-CoA reductase inhibitor)

hyperlipidemia (hypercholesterolemia)

decreases the amount of cholesterol produced by the liver

can cause myalgia (muscle pain) and rhabdomyolysis (muscle breakdown)

tell doctor right away if the patient has unexplained muscle pain, tenderness, weakness, fever or have cola colored urine

this drug is pregnancy category X and should not be take during pregnancy

levothyroxine (T4)

synthroid, levoxyl, levothroid

endocrine drug/thyroid hormone

treats hypothyroidism

helps restore thyroid hormone (T4) levels by replacing the amount that a patient’s body is missing

therapeutic effect can take 4-6 weeks

overdose can lead to symptoms of hyperthyroidism such as hypoglycemia, tachycardia or irregular heartbeat, heart failure, fluid loss, anxiety and insomnia

if patient’s thyroid levels are stable in a particular dose of one manufacturer’s levothyroxine, they cannot be switched to another manufacturer’s formulation of levothyroxine

lisinopril

prinivil, zestril

antihypertensive drugs (ACE inhibitor)

hypertension, heart failure, chronic kidney disease

ACE stands for angiotensin converting enzyme, this enzyme converts the hormone angiotensin1 to angiotensin 2

causes a dry hacking cough in 10% of patients who take this drug

metformin

glucophage, glucophage xr

antidiabetic

used for type 2 diabetes

works to decrease blood glucose by three different actions. 1) prevents the liver from making glucose, a process called gluconeogenesis. 2) prevents the GI tract from absorbing as much glucose from our diet as it wants to. 3) makes the cells more sensitive to insulin which will increase the uptake of glucose from the blood into the cells.

biggest adverse effect is flatulence and diarrhea that goes away as the patient’s body adjusts to having metformin on board. For this reason, patients are usually started on a lower dose and then tapered up to the desired dose.

amlodipine

norvasc

antihypertensive, calcium channel blocker

hypertension and angina

prevents vasoconstriction by blocking calcium from the flowing through calcium channels

can cause peripheral edema (swelling in the ankles and feet)

metoprolol

Lopressor, Toprol-XL

beta blocker

hypertension, angina, atrial fibrillation, post myocardial infarction

non-selective beta blockers block the adrenergic receptors (antagonistic) and prevent epinephrine and norepinephrine from binding the receptors. This causes the heart to beat more slowly and with less force. Also helps to widen blood vessels by blocking alpha receptors and can cause bronchoconstriction due to the beta 2 receptors in the lungs. Propranolol and Carvedilol are non-selective beta blockers.

Metoprolol is a beta 1 selective blocker - it only blocks the beta 1 receptors in the heart.

Can cause symptoms of low BP or HR such as light headedness/dizziness and orthostasis

have a boxed warning that they should not be abruptly stopped because it can leas to tachycardia and hypertension

albuterol

ventolin, proventil

short acting beta agonist bronchodilator

asthma and chronic obstructive pulmonary disease (COPD)

it binds to the beta 2 adrenergic receptors in the lungs which leads to bronchodilation

inhaled drug

side effects are sue to the agonist effect on the adrenergic receptors: tachycardia, tremor, hypertension

omeprazole

prilosec

proton pump inhibitor (PPI)

gastroesophageal reflux disease (GERD), ulcerations of the GI tract, erosive esophagitis, and frequent or chronic heartburn

proton pump inhibitors block the proton pump and prevent the production of stomach acid

rare adverse effects from long-time use of PPIs include: nutritional deficits, pneumonia, bacterial gastroenteritis, C. Diff diarrhea, osteoporosis

losartan

cozaar

angiotensin receptor blocker (ARB), antihypertensive

hypertension, heart failure, chronic kidney failure

blocks the angiotensin receptors which prevents the effects of angiotensin 2 on the kidneys and vascular smooth muscle

ARBs and ACE inhibitors should never be used in combination

fairly well tolerated medication

simvastatin

zocor

statin drug - antihyperlipidemic (HMG-CoA reductase inhibitor)

hyperlipidemia (hypercholesterolemia)

most cholesterol in the body is made by the liver. Simvastatin helps decrease the amount of cholesterol made in the body by inhibiting an enzyme called HMG-CoA reductase (an enzyme involved in the production of cholesterol by the liver). When this enzyme is inhibited, the liver decreases the amount of cholesterol it makes.

can cause myalgia (muscle pain) and rhabdomyolysis (muscle breakdown)

tell doctor right away if the patient has unexplained muscle pain, tenderness, weakness, fever or have cola colored urine

this drug is pregnancy category X and should not be take during pregnancy

gabapentin

neurontin

anticonvulsant

seizures, neuropathic pain (post-herpetic neuralgia, diabetic neuropathy)

GABA stands for gamma-aminobutyric acid. GABA is an inhibitory neurotransmitter in the brain and is thought to slow or stabilize nerve conduction in the central nervous system (CNS). Gabapentin is structurally related to GABA. Gabapentin can bind to and activate the GABA receptors causing a slowed or stabilized nerve conduction in the CNS.

side effects include: dizziness, somnolence (drowsiness, sleepiness, lethargy), peripheral edema

acetaminophen/hydrocodone

vicodin, norco

opioid (narcotic) analgesic

moderate to severe pain, chronic pain, cough, diarrhea

opioids come from the opium poppy plant. Some medications are extracted directly from the poppy plant: morphine, codeine. Some medications are synthetic and a molecule similar to opium is made in a laboratory: fentanyl, oxycodone, hydrocodone.

Opioids are agonists - meaning they bind to opiate receptors and elicit a response as if it were the natural substance binding to it. Endogenous opioids help regulate the body’s response to pain among other functions. (endogenous opioids = beta-endorphins and enkephalins) When activated by opioids like hydrocodone, these opiate receptors decrease pain transmission to the brain, thereby eliciting an analgesic effect.

hydrocodone can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Can be habit forming even at regular doses. Misuse of a narcotic or opioid medicine can cause addiction, overdose, or death.

acetaminophen (APAP) = Tylenol, daily max dose = 4 g, an overdose of APAP can damage your liver or cause death

hydrochlorothiazide (HCTZ)

microzide

diuretic

high blood pressure, edema

“water pill”

The functional unit of the kidney is the nephron. HCTZ prevents the distal convoluted tubule of the nephron from being able to reabsorb sodium back into the blood. Water follows sodium, so if we are excreting more sodium in our urine, water is going to follow. If we have less water in our blood, our blood volume will decrease, thus lowering the blood pressure.

Can cause dehydration and electrolyte imbalances.

sertraline

zoloft

selective serotonin reuptake inhibitor (SSRI) antidepressant

depression, anxiety, obsessive compulsive disorder (OCD), panic disorder, bulimia, post traumatic stress disorder (PTSD), other off label uses

work by blocking the reuptake of serotonin which increases the amount of serotonin available to bind to its receptors in the brain.

Takes 4-6 weeks to notice a therapeutic effect but adverse effects are felt right away. (nausea, sexual dysfunction and decreased libido, insomnia or sedation) Block box warning that states that patients have an increased risk of suicidal thinking and behavior, particularly in adolescents and young adults under the age of 24.

montelukast

singulair

leukotriene receptor antagonist

asthma (oral adjunct therapy in addition to inhaled medications), allergic rhinitis

Block pro-inflammatory substances called leukotrienes from bonding to their receptor. By not being able to bind to their receptor, they can not cause their effects such as inducing airway edema, bronchoconstriction, and inflammation.

This is an oral medication. Little to no adverse effects, but post marketing reports have shown some neuropsychiatric events such as: altered mental status, agitation, aggressive behavior, anxiousness, depression, hallucinations, insomnia, restlessness, suicidal ideation, tremor.

fluticasone

flonase, flovent HFA (hydrofluoroalkane), flovent diskus

inhaled corticosteroid, steroidal anti-inflammatory

symptoms of allergic rhinitis, asthma, and COPD

corticosteroids suppress the immune system and therefore suppress inflammation.

Common side effects include: hoarseness, throat irritation, headache, dryness in mouth, nose, throat, white patches or sores inside mouth or on lips, stuffy nose, sinus pain, cough or deepened voice.

Not for acute or short-term symptoms - this is not a rescue inhaler.

can take 1-2 weeks to take a full effect.

patients need to rinse mouth after each use to prevent thrush (steroids suppress immune system).

amoxicillin

amoxil

penicillin antobiotic, beta-lactam antibiotic

bacterial infections of the upper respiratory system

inhibits bacterial cell wall synthesis which leads to the death of the bacteria. amoxicillin treats bacterial infection by inhibiting bacterial cell wall growth: amoxicillin binds to the transpeptidase’s active site, amoxicillin blocks transpeptidase’s activity, amoxicillin interrupts bacterial cross-linking and cell wall synthesis.

patient needs to complete the entire course of the prescription even if they feel better.

flurosemide

lasix

loop diuretic

fluid retention (edema) in patients with congestive heart failure, liver disease or kidney disorder

diuretics work in the kidneys. functional unit of the kidney is the nephron. furosemide works primarily at the ascending loop of henle in the nephron to prevent electrolyte and water reabsorption thus helping the body to excrete more fluid.

can decrease potassium and magnesium levels to the point of needing to supplement these electrolytes.

can cause ototoxicity at high doses

can lead to dehydration

pantoprazole

protonix

proton pump inhibitor

disorders of elevated stomach acid, GERD, ulcerations in the GI tract, erosive esophagitis, frequent heart burn

proton pump inhibitors block the proton pump in the parietal cells of the stomach and prevent the production of stomach acid.

rare adverse effects from long-time use of PPIs include: nutritional deficits, pneumonia, bacterial gastroenteritis, C.Diff. Diarrhea, osteoporosis

acetaminophen (APAP)

tylenol

analgesic/antipyretic

mild to moderate pain fever

Exact mechanism of action is not fully known. It relieves pain by elevating the pain threshold - in other words, a person would have to have more pain before they feel it. It reduces fever by acting on the heart regulating center of the brain and telling it to lower the body’s temperature.

Well tolerated but can cause liver damage if taken incorrectly or in too high of doses. Patient needs to be aware when taking combination products that have APAP. The official maximum daily dose is 4 grams or 4000 mg but the suggested daily maximum dose has been lowered to 3 grams or 3000 mg. Tylenol does not have anti-inflammatory effects even though it is often classified with non-steroidal anti-inflammatory drugs such as ibuprofen.