Pharmacology Exam 3 Prototype Drugs

Loop diuretic

furosemide (Lasix)

Loop diuretics

MOA: blocks Na+ reabsorption in the loop of Henle

Uses:

- reduce HF edema

- hepatic cirrhosis

- renal failure

Loop diuretics

Adverse effects:

- electrolyte imbalances; particularly hypokalemia

- dehydration

- hypotension

- orthostatic hypotension

- syncope

- ototoxicity

Contraindications:

- anuria

- hepatic coma

- severe fluid/electrolyte depletion

Thiazide diuretic

hydrochlorothiazide (HCTZ)

Thiazide diuretic

MOA: blocks Na+ reabsorption and increases K+ and H2O excretion

Uses:

- mild-moderate HTN

- heart, hepatic, renal failure

Thiazide diuretic

Adverse effects:

- electrolyte imbalances; particularly loss of K+ and Na+

- cardiac conduction abnormalities due to hypokalemia

- gout attacks due to hyperuricemia

Contraindications:

- anuria

- preeclampsia

- pregnancy induced HTN

Potassium sparing diuretic

spironolactone (Aldactone)

Potassium sparing diuretic

MOA: blocking Na+ or aldosterone; controls renal reabsorption of Na+ or K+

Uses: patients with K+ deficiencies who are on diuretics

Potassium sparing diuretic

Adverse effects:

- risk of hyperkalemia if pt is taking K+ supplements or ACE inhibitors

- in men = gynecomastia, impotence, diminished libido

- in women = menstrual irregularities, hirsutism, breast tenderness

Contraindications:

- anuria

- renal function impairment

- hyperkalemia

- pregnancy/lactation

- use of salt substitutes

Anticoagulant

heparin (parenteral), warfarin (oral)

Anticoagulant

MOA: inhibit specific clotting factors to prevent the formation/enlargement of clots

Uses:

- prevent clots in veins

- treat thromboembolic disorders

Anticoagulant

Adverse effects:

- heparin = abnormal bleeding, heparin-induced thrombocytopenia (HIT)

- warfarin = abnormal bleeding

Contraindications:

- active internal bleeding

- bleeding disorders

- severe HTN

- recent trauma

- intracranial hemorrhage

- bacterial endocarditis

aPTT

monitor ______ for heparin

PT/INR

monitor _______ for warfarin

LMWH (low molecular weight heparin)

enoxaparin (Lovenox)

MOA: used prophylactically to prevent blood clots from forming

Antiplatelet

clopidogrel (Plavix)

Antiplatelet

MOA: alters plasma membrane of platelets so they can't aggregate; prolongs bleeding time

Uses: prevention of thrombi after stroke or MI

Antiplatelet

Adverse effects:

- flu-like syndrome

- headache

- dizziness

- bruising

- rash

- pruritus

- bleeding

Contraindications:

- active bleeding

Erythropoietin

epoetin alfa

Erythropoietin

MOA: functions the same as natural erythropoietin to simulate erythropoiesis

Uses: treatment of RBC formation deficiencies

- monitor CBC, PTT, INR, iron

Colony-stimulating factors

filgrastim (Granix, Neupogen)

Uses: increase neutrophil production

Platelet enhancers

oprelveskin (Neumega)

Platelet enhancers

MOA: simulates activity of megakaryocytes and thrombopoietin

Uses: patients with thrombocytopenia

Adverse effects: bleeding risk

Antihistamine

diphenhydramine (Benadryl)

Antihistamine

MOA: blocks H1 receptors

Uses: treatment of allergic reactions and common cold

Antihistamine

Adverse effects:

- drowsiness

- paradoxical CNS stimulation/excitability

- anticholinergic effects (dry mouth, tachycardia, mild hypotension)

- photosensitivity

Contraindications:

- BPH

- narrow-angle glaucoma

- GI obstruction

- use cautiously with asthma and hyperthyroidism

Intranasal corticosteroid

fluticasone (Flonase, Veramyst)

Intranasal corticosteroid

MOA: decreases local nasal passage inflammation, reducing nasal stuffiness

Uses: treatment of seasonal allergic rhinitis

Intranasal corticosteroid

Adverse effects:

- swallowing = systemic adverse effects

- nasal irritation

- epistaxis

- headache

- nasopharyngitis

Contraindications:

- bacterial, viral, fungal, or parasitic infections

Sympathomimetic

oxymetazoline (Afrin)

Sympathomimetic

MOA: stimulates alpha-adrenergic receptors in the SNS causing the nasal arterioles to constrict

Uses: treatment of nasal congestion

Sympathomimetic

Adverse effects:

- rebound congestion

- dry nasal mucosa

Contraindications:

- thyroid disorders

- HTN

- diabetes

- heart disease

Antitussive

dextromethorphan (Delsym, Robitussin DM)

Antitussive

MOA: acts on the medulla to increase the cough threshold

Uses: to suppress coughs

Antitussive

Adverse effects:

- dizziness

- drowsiness

- GI upset

- CNS toxicity (if abused)

Contraindications:

- chronic cough due to excessive bronchial secretions (asthma, smoking, emphysema)

Bronchodilator (beta2-adrenergic agonist)

albuterol

Bronchodilator (beta2-adrenergic agonist)

MOA: selectively binds to beta2-adrenergic receptors in bronchial smooth muscle to cause bronchodilation

Uses: termination of acute bronchospasm

Bronchodilator (beta2-adrenergic agonist)

Adverse effects:

- palpitations

- headaches

- throat irritation

- tremor

- nervousness

- restlessness

-tachycardia

- insomnia

- dry mouth

- chest pain

- paradoxical bronchospasm

- allergic reaction

Contraindications:

- use caution when administering to pts with a history of cardiac disease or HTN

Anticholinergic

ipratropium (Atrovent)

Anticholinergic

MOA: causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle

Uses: relief of acute bronchospasm

Anticholinergic

Adverse effects:

- irritation of upper respiratory tract

- coughing

- drying of nasal mucosa

- hoarseness

- bitter taste

- epistaxis

Contraindications:

- hypersensitivity to soya lecithin, soybeans, or peanuts

Methylxanthines

theophylline, aminophylline

Methylxanthines

Adverse effects:

- narrow margin of safety

- N&V

- CNS stimuation

- cardiac dysrhythmias

- nervousness

- insomnia

- drug-drug interactions

Methylxanthines

MOA: CNS stimulant (related to caffeine)

Uses: long-term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids

Inhaled corticosteroid

beclomethasone (Qvar)

Inhaled corticosteroid

MOA: reduces inflammation

Uses:

- decrease frequency of asthma attacks

- treating allergic rhinitis

Inhaled corticosteroids

Adverse effects:

- corticosteroid toxicity

- hoarseness

- dry mouth

- changes in taste

- cataracts

- growth inhibition (children)

- oropharyngeal candidiasis

Contraindications:

- active infection (masks symptoms)

- monitor growing children

Leukotriene modifiers

montelukast (Singulair)

Leukotriene modifiers

MOA: prevents airway edema and inflammation by blocking leukotriene receptors in the airways

Uses: prophylaxis and long-term treatment/prevention of asthma

Leukotriene modifiers

Adverse effects:

- headache

- nausea

- diarrhea

- neuropsychiatric events (suicidal ideation, hallucinations, aggressiveness, depression)

Contraindications:

- pre-existing hepatic impairment

SSRI

escitalopram (Lexapro)

SSRI

MOA: increases the availability of serotonin in the CNS by slowing the reuptake of it through blocking the receptors

Uses: generalized anxiety and depression

SSRI

Adverse effects:

- dizziness

- N&V

- insomnia

- somnolence (drowsiness)

- confusion

- seizures (overdose)

- anorexia

- sexual dysfunction

- dry mouth

Contraindications:

- breast-feeding pts

- within 14 days of MAOI therapy

Benzodiazepine

lorazepam (Ativan)

Benzodiazepine

MOA: binds to GABA receptor-chloride channel molecule, intensifying the effects of GABA

Uses: acute anxiety disorders and insomnia (short-term only) (also, seizure disorders, alcohol withdrawal, central muscle relaxation, anesthesia)

Benzodiazepine

Adverse effects:

- drowsiness

- dizziness

- respiratory depression

- cardiovascular collapse

- sedation

- amnesia

- weakness

- disorientation

- ataxia

- sleep disturbances

- BP changes

- blurred or double vision

- N&V

- HIGHLY ADDICTIVE

Contraindications:

- acute narrow-angle glaucoma

- closed-angle glaucoma

- liver disease

- drug abuser

- impaired brain function

- suicidal thoughts

SSRI

sertraline (Zoloft)

SSRI

MOA: inhibits reuptake of serotonin in the brain

Uses: depression, anxiety, OCD, social anxiety

SSRI

Adverse effects:

- sexual dysfunction

- nausea

- headache

- weight gain

- anxiety

- insomnia

- sedation

- anticholinergic effects

- sympathomimetic effects

TCAs

imipramine (Tofranil)

TCAs

MOA: blocks reuptake of NE and serotonin

Uses: major depression

TCAs

Adverse effects:

- orthostatic hypotension

- sedation

- anticholinergic effects

- cardiac dysrhythmias

- 2nd line drug because of cardiac affects

Barbiturate

phenobarbital (Luminal)

Barbiturate

MOA: enhances GABA

Uses: controlling seizures

Barbiturate

Adverse effects:

- drowsiness

- vitamin deficiencies

- laryngospasm

- respiratory depression

- CNS depression

- coma

- death

- agranulocytosis

Contraindications:

- severe uncontrolled pain

- pre-existing CNS depression

- porphyria

- severe respiratory disease with dyspnea or obstruction

- glaucoma

- prostatic hypertrophy

Benzodiazepine

diazepam (Valium)

Benzodiazepine

Adverse effects:

- drowsiness

- dizziness

- tolerance

- dependency

- muscular weakness

- tachycardia

- respiratory depression

Contraindications:

- shock

- coma

- depressed vital signs

- acute narrow-angle glaucoma

- untreated open-angle glaucoma

- within 14 days of MAOI therapy

Hydantoin

phenytoin (Dilantin)

Hydantoin

MOA: desensitizes sodium channels

Uses: treatment of all types of epilepsy except for absence seizures

Hydantoin

Adverse effects:

- cardiac dysrhythmias

- gingival hyperplasia

- rashes

- hypotension

- hyperglycemia

- headache

- nystagmus

- ataxia

- confusion

- slurred speech

- paradoxical nervousness

- twitching

- insomnia

- peripheral neuropathy

Contraindications:

- rashes

- seizures due to hypoglycemia

- sinus bradycardia

- heart block

Phenytoin-like

valproic acid (Depakene)

Phenytoin-like

MOA: desensitizes sodium channels

Uses: treatment of a wide range of seizures, including absence and mixed seizures

Phenytoin-like

Adverse effects:

- CNS depression

- ataxia

- vertigo

- headache

- SJS

- sedation

- drowsiness

- GI upset

- prolonged bleeding time

- visual disturbances

- muscle weakness

- tremor

- psychomotor agitation

- bone marrow suppression

- weight gain

- abnormal cramps

- rash

- alopecia

- pruritus

- photosensitivity

- erythema multiforme

- fatal hepatotoxicity

Contraindications:

- liver disease

- bleeding dysfunction

- pancreatitis

- congenital metabolic disorders

Bipolar medication

lithium (Eskalith)

Bipolar medication

MOA: affects sodium transport across cell membranes

Uses: bipolar disorder

Bipolar medication

Adverse effects:

- N&V

- diarrhea

- hair loss

- weight gain

- acne

- sedation

- tremors

- incoordination

- adverse thyroid and kidney effects (long term therapy)

Contraindications:

- dehydration

CNS stimulant

methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin)

CNS stimulant

MOA: heightens awareness and increases focus

Uses: treatment of ADHD

CNS stimulant

Adverse effects:

- nervousness

- insomnia

- anorexia

- weight loss

- irregular heart beat

- high BP

- liver toxicity

Contraindications:

- history of anxiety

- psychosis

- suicidal ideation

- glaucoma

- motoritics

- Tourette's disease