Common Drug Prefixes, Suffixes, Root Words for Major Drug Classifications-(why didn't I learn this sooner)

-adol

analgesics (painkiller for anypain in general)

(an=not, algia=pain)(analgesic=no pain)

ex. tramadol=Tylenol (acetominophen)

(*WARNING: not all analgesics have opioid. Tylenol itself is an NSAID (no opioid)

anything with opioid (narcotic) is a schedule ____ drug

Schedule II drug prefixes:

-one, -done

-

II

Schedule III drugs:

Schedule IV drugs:

-adol

-one,-done

analgesics-opioid (painkiller)

adol takes cocaine

ex. hydrocodone (norco, vicodin); hydromorphone (dilaudid); oxycodone

-ane

anesthesia (numbs)

*used in the operating room

(*cuz only anesthesia is used for surgery)

Jane is numb after saying bye to Tarzan

ex) cyclohexane, ethane, flurane

-caine

anesthesia (numbs skin/CNS)

Jane takes cocaine

Ex. bupivacaine, cocaine, lidocaine

-nitrate, nitro-

antianginals

(*anti=against)(anginal=heart)

(*reduces heart attacks)

-lukast

antiasthmatic (*aka against allergies)

Lucas has allergies

-nacin

Anticholinergics

(*anti=against)(cholic=bladder)

-Used to treat bladder incontinence

(*anacin skywalker has bladder issues being in that suit for too long)

-rudin

Anticoagulant

-parin

anticoagulants

ex. heparin;Low Molecular Wt. Heparins (LMWH)

enoxaparin (Lovenox); dalteparin (Fragmin); tinzaparin (innohep)

-Heparin is "unfractionated" heparin (UFH); the others are low molecular weight heparin (LMWH). LMWH has less effect on thrombin but greater effect on Factor Xa.

- Advantages of UFH: Can be given IV; more response to protamine (antidote for heparin overdose)

- Advantages of LMWH: Less risk of heparin induced thrombocytopenia syndrome (HITS), POSSIBLY less risk of bleeding, frequent monitoring of PTT not necessary, less risk of osteoporosis if needed long-term

gab,gaba-

Anticonvulsants (anti- seizure) - GABA Analogue

ex. gabapentin* (neurontin),

prebalin (lyrica), tiagabine 9Gabitril)

-similar effect as GABA (CNS depressant)

-toin

Anticonvulsant (anti- seizure) -- Hydantoins

ex.ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin)*

CNS depressant

- phenytoin sometimes used as antiarrhythmics - Class I (Sodium Channel blocker) for preventing/treating ventricular arrhythmias

-pramine

Antidepressants -- Tricyclic antidepressant (TCA)

ex.Desipramine (Norpramin), imipramine (Tofranil), trimipramine (Surmontil)

-ALL TRICYCLICS: Block re-uptake of norepinephrine and serotonin. ALL TRICYCLICS: Many drug interactions. Do not give with MAO-inhibitors

-TRIcyclics (TRI = 3 = 3 weeks until onset of action)

- ALL TRICYCLICS: Side Effects = HATS: Hypotension, Anticholinergic (Can't see,

spit, pee, shit), Tachycardia, Sedation

-antihistamine (dry mucus, sleepiness)

-tyline

Antidepressants - Tricyclic antidepressant (TCA)

ex.amitriptyline* (Elavil), nortriptyline (Pamelor), protriptyline (Vivactil)

-citalopram

antidepressants-Selective Serotonin Reuptake Inhibitors (SSRIs)

ex. citalopram (Celexa); escitalopram (Lexapro);

- Weight gain ~10 lbs - around 25% of people on SSRIs

- As with all antidepressants (increased risk of suicide)

-oxetine

Antidepressants - Selective Serotonin Reuptake Inhibitors (SSRIs)

-fluoxetine (Prozac); paroxetine (Paxil); duloxetine* (Cymbalta)

- Duloxetine (Cymbalta) blocks reuptake of both serotin and norepinephrine

(SNRIs)

-Nausea is common for SNRIs - can cause patient to DC Rx

- Increased risk of bleeding if concurrently taking aspirin, NSAIDs, or oral

anticoagulants.

-Can have antidepressant discontinuation syndrome - flu-like sx, insomnia,imbalance, hyperarousal, sensory disturbances

-setron

Antiemetics - serotonin 5-HT3 receptor antagonist

-alosetron, dolasetron (Anzemet), granisetron (Sancuso), ondansetron (Zofran)*, palonosetron (Aloxi)

-Blocks the serotonin receptors in the vomiting center and small intestine. One of the most effective of all anti-emetic classes.

- Few side effects - most common are headache, constipation, diarrhea

-Can prevent anticipatory nausea and vomiting associated with cancer chemotherapy

-iramine

-Antihistamines

brompheniramine, chlorpheniramine, pheniramine

- Used to treat allergic conditions

Primary SE: drowsiness, dry mouth and throat

-pril

Antihypertensives - angiotensin converting enzyme (ACE) inhibitors

Benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), moexipril (Univasc), quinapril (Accupril) , lisinopril* (Prinivil, Zestril)

-block conversion of angiotensin I to angiotensin II--> less vasoconstriction

-dry COUGH is one of the most common side effects, cough can become permanent (remember ACE is produced by lungs)

- lower Aldosterone --> risk of hyperkalemia

-Can cause angioedema that starts at back of throat and progresses - may leadto cardiac arrest.

-azosin

Antihypertensives -- Alpha adrenergic blockers

doxazosin, prazosin, terazosin

- Vasodilator; anti-hypertensive

-dipine

Antihypertensives /Cardiovascular Drugs -- Calcium channel blockers

amlodipine* (Norvasc, Lotrel), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop)

-Used to prevent or treat angina or hypertension

- Watch for hypotension, worsening CHF, heart block

-Not recommended for patients > 60 becauses causes constipation

-Do not drink grapefruit juice while on these drugs - decreases metabolism of drug, more susceptible to toxicity

-sartan

Antihypertensives -- Angiotensin II receptor blockers (ARBs)

ex. candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan)

- Block effects of angiotensin II at its receptor --> lowers vasoconstriction, and lowers aldosterone

- Used to treat HTN and heart failure. Used for patients who cannot tolerate ACE inhibitors, but ARBs not as effective

- Slows progression of kidney disease r/t HTN or DM

-Contraindicated in pregnancy - causes birth defects

-lol,olol

Antihypertensives/ Cardiovascular Drugs -- Beta adrenergic blockers

ex. atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Cartrol), metoprolol (Lopressor), nadolol (Corgard), propranolol, sotalol

- "olol" drugs may be cardioselective (block only beta-1), or non-selective (block beta-1 and beta-2)

-Used for HTN, glaucoma (ophthalmic eye drops), prevent recurrent MI, prevent migraines, panic attacks (decrease palpitations and SNS stimulation).

-Avoid abrupt withdrawl of beta-blockers - may cause increased angina and MI

- Blocking beta-1 -lower heart rate, lower speed of conduction, lower speed of impulse conduction

- Blocking beta-2 --> lower renin release by kidneys ( lower BP), lower glycogenolysis--> lower

blood glucose and insulin needs, lower dilation of skeletal blood vessels

-vastatin

Antilipemics (cholesterol lowering drugs) - HMG- CoA reductase inhibitor

ex.atorvastatin, lovastatin, simvastatin

- Inhibit the enzyme (HMG-CoA) needed for cholesterol synthesis in liver

- SE liver dysfunction, avoid in patients with liver failure

-dazole

Antimicrobials -- Antihelminthic, antibiotic, antibacterial

albendazole, mebendazole, metronidazole, tinidazole

-conazole

Antimicrobials - Antifungals (Antimycotics)

Butoconazole (Gynazole), fluconazole* (Diflucan), ketoconazole (Feoris, Nizoral), tioconazole (Monistat-1)

- Used for candidiasis, coccidiomyosis, histoplasmosis, fungal infections of skin and nails

- Many drug interactions - severe reactions (life-threatening arrhythmias) possible when concurrent with antihistamines

- Monitor liver function tests - all "conazole" antifungal agents are hepatotoxic, esp in combo with other hepatotoxic agents

-quine

Antimicrobials -- Antiparasitics

ex. chloroquine, hydroxychloroquine, mefloquine

-Primarily used in prevention and treatment of malaria.

-Anti-malarial drug resistance common

- Chloroquine and hydroxychloroquine are sometimes used in Rx rheumatoid

arthritis and lupus

- Sometimes associated with cinchoism syndrome: tinnitus, rash, vertigo, nausea,

vomiting, abdominal pain

-cyclovir

Antimicrobials -- Antivirals

ex. acyclovir, valacyclovir

-Used to treat herpes' related infections. Does not eradicate the virus, just alleviates symptoms and manifestations

-vir

Antimicrobials -- Antivirals

ex. abacivir, acyclovir, zanamivir

-Acyclovir - primarily only effective against herpes related infections

-micin, -mycin

Antimicrobials /Antibiotics -- Aminoglycosides

ex. gentamicin (Garamycin), neomycin (Neo-Fradin), tobramycin (Nebcin)

-Bactericidal - interfere with bacterial protein synthesis, disrupt structure of bacterial cell wall

- Used for severe infections and hospital-acquired gram-negative respiratory infections

-SE: Can't hear (ototoxicity, tinnitus, also balance problems), pee (nephrotoxicity, increased BUN/Cr - worse if on loop diuretics), or stand (decreased vestibular function).

-Given parenterally, not orally - break down in stomach

cef-, ceph-

Antimicrobials /Antibiotics -- Cephalosporins

ex. cephalexin (Keflex), efdinir (Omnicef),

-Beta-lactam antibiotics - Bactericidal; inhibit bacterial cell wall synthesis

- Similar structure to penicillin - if allergic to PCN, may be allergic to

cephalosporins, but not necessarily

-3x more effective than penicillin for treating bacterial throat infections like strep throat

=4 Generations of cephalosporin antibiotics: As move from 1st to 4th generation, become more broad-spectrum (effective against both gram positive and gram negative)

-floxacin

Antimicrobials/ Antibiotics - Fluoroquinolones

ex. Ciprofloxacin (Cipro), gatifloxacin (Tequin), levofloxacin (Levaquin), Moxifloxacin (Avelox)

-Bactericidal - only antimicrobial agents that directly inhibit bacterial DNA synthesis

-Broad-spectrum antibiotic - variety of gram positive and gram negative infections, including anthrax and pathogens resistant to other antibiotics

- Fluoroquinolone use increases likelihood of tendonitis and tendon rupture

-cillin

Antimicrobials -- penicillins

ex. Amoxicillin (Amoxil), ampicillin (Omnipen), piperacillin (Pipracil), ticarcillin (Ticar), penicillin V (Pen-VK)

- Bactericidal. Inhibits bacterial cell wall synthesis.

- Most common problems are allergic reactions and resistance. Relative or

absolute contraindication if known allergic reactions to other penicillins or

cephalosporins.

- Bacteria can develop an enzyme (penicillinase) that can increase resistance topenicillins.

rifa-

Antimicrobials -- Antituberculars

ex. rifamate, rifampin, rafapentine, rifater

-Hepatotoxicity

- Red-orange color to body fluids - tears, saliva, urine, sweat, sputum. May

permanently stain soft contact lenses

-vudine

Antimicrobials-- Antivirals - nucleoside analogue

ex. lamivudine, stavudine, telbivudine, zidovudine

-Reverse transcriptase inhibitor, used for the treatment of HIV/AIDS

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-thromycin

Antimicrobials/ Antibiotics -- Macrolide

ex. erythromycin, azithromycin

- Do NOT confuse with the "-mycin" drugs - gentimicin, tobramycin - which are bactericidal and different class than the "-thromycin" drugs.

- Bacteriostatic - inhibits bacterial growth but does not eradicate bacterial colonies. -Used for infections in Resp and GI tract and soft tissues, prophylactic prior to dental procedures

- Give on an empty stomach (1 hour before or 2 hours after meals) with water only - juice and food decreases drug activity

- Several drug interactions - can increase bioavailability (and therefore risk of toxicity) of digoxin, theophylline (bronchodilator), carbamazepine and dilantin (anti-seizure meds), warfarin (coumadin), methylprednisolone

- Caution in elderly on calcium channel blockers - may cause hypotension and/or shock

sulf-

Antimicrobials/ Antibiotics -- Sulfonamides

ex. sulfamethizole (Thiosulfil Forte), sulfisoxazole (Gantrisin), trimethoprim- sulfamethoxazole (Septra, Bactrim)

-Bacteriostatic - inhibits bacterial growth by blocking folic acid synthesis in bacteriaUsed for UTIs, Pneumocystis Carinii, shigellosis, some protozoal infections

-Take on empty stomach with at least 8 oz of water; 24 hour fluid intake at least 1500 ml water/ day

- May cause false positive urine glucose and ketone tests

- Increased skin sensitivity to sun - protect from direct sunlight

-cycline

Antimicrobials/ Antibiotics -- Tetracyclines

ex. demeclocycline (Declomycin), doxycycline* (Vibramycin), minocycline (Minocin), tetracycline (Sumycin)

- Bacteriostatic - inhibits bacterial protein synthesis by binding to bacterial ribosomes

- Contraindicated in pregnancy and children < 8 y.o - may interfere with bone growth

- Take on empty stomach with full glass of water (no dairy product)

- Repeated or continual use may cause teeth blackening of developing teeth

- May decrease effectiveness of some oral contraceptives - should use alternative

method of birth control

-triptan

Antimigraine - selective 5-HT receptor agonist

ex. rovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex)

- Agonistic effect on 5-HT receptors on cranial arteries and veins, causing vasoconstriction and decreased vascular inflammation

- Can cause acute cardiac events such as vasospasm, myocardial ischemia/infarction, ventricular tachycardia/ ventricular arrhythmias

-stine

Antineoplastics - alkylating agent

carmustine, estramustine, lomustine, vinblastine (Velban), vincristine (Oncovin)

-Alkylating Agents: Work by methylating DNA, thereby interfering with DNA

replication

- Vincristine causes peripheral neuropathies - resulting in numbness or

neuropathic-type pain

-abine

Antineoplastics -- Antimetabolite

ex. capacitabine, cytarabine, fludarabine

- ALL Antineoplastics: Will affect dividing cells preferentially - hair follicles (alopecia); GI mucosa (mucositis, diarrhea, nausea, vomiting); bone marrow (anemia -- fatigue, thrombocytopenia - susceptibility to bleeding), leukopenia - susceptibility to infections); skin (increased risk of skin breakdown and sunburn); lung mucosa (pulmonitis); impaired growth and development in children (or fetuses in pregnant women), sperm, ova maturation

-5-Fluorouracil (5-FU) and Methotrexate are also common drugs in this antimetabolite category, even though they are not "abines"

- ALL Antineoplastics: Work by interfering with DNA synthesis and/or replication. Any factor that affects DNA or RNA can increase risk of carcinogenesis and metastasis, i.e., cancer treatments can causes cancer as well as treat cancer

-Antimetabolites interefere with the synthesis and/or activity of the ingredients/nutrients needed for DNA synthesis; most active during S-phase of cell cycle.

- Since antimetabolites work by interfering with the cell's utilization of nutrients and promoting oxidation of cancer cells, patients should be instructed to avoid taking high dose vitamins and antioxidants without prescription by or consultation with physician/oncologist

-nib

Antineoplastics - biologic response modifier

ex. dasatinib, erlotinib (Tarceva), imatinib (Gleevac), sorafenib (Nexavar)

-These drugs work through various mechanisms to interfere with oncogene

activation - thereby inhibiting cell proliferation.

-bicin

Antineoplastics - Mitotic inhibitor

ex. doxorubicin, epirubicin, idearubicin, valrubicin

-Antitumor antibiotics inhibit RNA synthesis, thereby slowing or inhibiting

mitosis. Most useful in slow-growing tumors

The "bicin" antineoplastic drugs tend to be especially toxic to heart and lungs;

more so than other cancer chemotherapy drugs

-capone

Antiparkinson Agent - Catechol O- Methyltransferase (COMT) Inhibitor

ex.entacapone (Comtan); tolcapone (Tasmar)

- Blocks degradation of neurotransmitters - norepinephrine, dopamine. Makes more dopamine available for brain receptors.

- Used for relief of Parkinson sx - tremors, stiffness/rigidity, balance

- EPS Sx - uncontrolled movements of face, head, neck, mouth, upper extremities

- drooling - associated with all Antiparkinson drug. Can be relieved with anticholinergics, but these drugs will cause increased dementia in elderly.

-giline

Antiparkinson Agent - MAO-B inhibitor

ex. Rasagiline (Azilect); Selegiline (Ensam, Eldepryl, Zelapar)

- Blocks the monamine oxidase enzyme that degrades norepinephrine, dopamine, serotonin - makes more dopamine available for brain cells

-same S/E's as -capone drugs

--zine, azine

Antipsychotics - typical; Antiemetics -- Phenothiazines

ex. chlorpromazine (Thorazine), perphenazine (Trilafon), prochlorperazine (Compro), promethazine*(Phenergan), trifluoperazine (Stelazine)

-Dopamine blockers - block effect of dopamine in chemoreceptor trigger zone.

- SE: Parkinson's like symptoms - tremors, extrapyramidal symptoms (EPS),

problems with posture/balance, uncontrolled movements of head/neck/upper

extremities, drooling, etc.

- Chlorpromazine (Thorazine) - used to treat refractory hiccups

-idone, peridol,

Antipsychotic - atypical (2nd generation)

ex. Paliperidone (Invega), resperidone (Risperdal); ziprasidone (Geodon); Iloperidone (Fanapt)

- Blocks Dopamine (D2) receptors and serotonin receptor 5HR2A

- Can cause major weight gain and changes in metabolism - also risk of Diabetes

and hyperlipidemia

- Watch for EPS Sx (tremors, abnormal movements - esp. head, neck, upper

extremities)

-pine

Antipsychotics - atypical (2nd generation)

ex. clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel)

-same as for other atypical (2nd generation) antipsychotics as described above.

-prazole

Anti-Ulcer -- Gastric proton pump inhibitors (anti-ulcer)

ex. esomeprazole(Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix)

- Inhibit gastric acid production by the parietal cells on the surface of the stomach

-May increase bioavailability (thereby increasing risk of toxicity) of anticoagulants, diazepam, and dilantin

-tidine

Anti-Ulcer -- H2 receptor antagonists

Cimetidine (Tagamet), famotidine*(Pepcid), niazatidine (Axid), ranitidine (Zantac)

- Prevent histamine-induced gastric acid production

- Headache - most common side effect

- May cause temporary confusion in severely ill patients > 50 yrs old

- Hepatic/Renal toxicity/Bone Marrow Suppression more common with

cimetidine than other H2 inhibitors

- Many drug interactions. Avoid alcohol, NSAIDs, smoking, strong spices.

- If oral - take at least 1-2 hours apart from antacids

-dronate

Biphosphonates -- Bone resorption inhibitor

ex. alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel)

- Inhibits resorption of calcium from bone to blood. Given to prevent or treat osteoporosis

- Irritating to esophagus GI tract - if taken orally, should take with at least 6-8 oz water on empty stomach, sit upright or stand for at least 30 minutes after taking.

- Maintain normal serum and cellular levels of calcium via Calcium and Vitamin D supplements. Usually the bones will release calcium to maintain normal serum calcium levels, but biophosphonates prevent this.

-terol

Bronchodilators - beta-2 agonist

ex.

-Short-Acting:

albuterol* (Proventil), levalbuterol (Xopenex), metaproteronol (Alupent), pirbuterol (Maxair)

-Long-Acting:

Arformoterol (Brovana); formoterol (Foradil), salmeterol (Serevent)

- Can also get some beta-1 effects with these drugs --> increased heart rate, increased SNS stimulation

--> lower effects if on beta blockers.

- If inhaler - 1-3 minutes between puffs.

-If also taking corticosteroid inhaler - take beta-2 inhaler 1st to open the airways,

wait 5-15 minutes, then corticosteroid inhaler

-phylline

Bronchodilators - xanthine derivative

ex.Aminophylline (Phyllocontin), dyphylline, oxytryphylline, theophylline (Theo-Dur, Slo-Bid)

-Relaxes smooth muscle of bronchi and bronchioles by increasing intracellular cAMP -> increased bronchodilation

- Has a CNS stimulant effect - can cause tachycardia, nervousness, tremors, visual hallucinations, seizures

-Monitor blood levels - therapeutic = 10-20 mcg/ml blood; toxic > 20 mcg/ml. Narrow therapeutic window.

-tropium

Bronchodilators - anticholinergic

ex.ipratropium (Atrovent);tiotropium* (Spiriva)

-Block the bronchoconstrictive effect of acetylcholine from parasympathetic system, promotes SNS which causes bronchodilation.

-Anticholinergic bronchodilators primarily used for treating smoking-related COPD

-stigmine

Cholinergic agonists

ex.neostigmine, physostigmine, pyridostigmine

-SLUD - salivation, lacrimation, urination, defecation

- Used to treat myasthenia gravis and overdose of neuromuscular blocking agents

like curare

-ine

CNS Stimulants

ex.

amphetamine and dextroamphetamine (Adderall), caffeine (NoDoz, Vivarin), dextroamphetamine (Dexedrine), terbutaline, theophylline, epinephrine, lisdexamfetamine (Vyvanse), norepinephrine, dopamine

-Terbutaline and theophylline are xanthine bronchodilators

- amphetamine + dextroamphetamine (Adderall) - used for hyperactivity,

attention deficit disorder

- Catecholamines such as epinephrine, norepinephrine, and dopamine are used to

prolong the SNS-mediated compensatory phase of shock.

- Prescription amphetamines may be used judiciously for increasing weight loss,

treating depression, treating hypothermia, narcolepsy. However side effects (tachycardia, hypertension, psychosis, seizures) and risk of addiction so high, amphetamines are almost never used as 1st line drug for any condition except perhaps ADHD

-cort

Corticosteroid

ex. clocortolone, fludrocortisones, hydrocortisone

- General Uses for all Corticosteroids: Treatment of chronic inflammatory disorders (e.g., gout, arthritis, asthma, chronic pain disorders, autoimmune disorders), prevention or treatment of acute or chronic organ rejection in transplantation

-General Adverse effects for all Corticosteroids: Cushing's Syndrome - hyperglycemia, hyperlipidemia, sodium and water retention, hypertension due to increased sensitivity to catecholamines, labile mood, striae (stretch marks), muscle atrophy, bruising and echymoses due to decreased protein stores. Increased susceptibility to infections; lipogenesis in certain areas (abdomen/waist, face [moon face], upper back [buffalo pump], masked signs of infection due to anti-inflammatory effects of glucocorticoids

-Avoid grapefruit and grapefruit juice decreases drug metabolism, may result in toxicity of the drug

-Should take in moring to simulate normal cortisone release by body

-Need to wean patients off steroids gradually or may cause acute adrenal crisis.F

onide, -sonide

Corticosteroid

ex. budesonide (Entocort, Pulmicort), desonide, fluocinonide, halcinonide

-General Adverse effects for all Corticosteroids: Cushing's Syndrome - hyperglycemia, hyperlipidemia, sodium and water retention, hypertension due to increased sensitivity to catecholamines, labile mood, striae (stretch marks), muscle atrophy, bruising and echymoses due to decreased protein stores. Increased susceptibility to infections; lipogenesis in certain areas (abdomen/waist, face [moon face], upper back [buffalo pump], masked signs of infection due to anti-inflammatory effects of glucocorticoids

-Avoid grapefruit and grapefruit juice decreases drug metabolism, may result in toxicity of the drug

-Should take in moring to simulate normal cortisone release by body

-Need to wean patients off steroids gradually or may cause acute adrenal crisis.

pred-

Corticosteroid

ex. loteprednol,

methylprednisolone (Medrol, Depo-Medrol), prednicarbate, prednisolone (Orapred, Prelone), prednisone Sterapred)

-General Adverse effects for all Corticosteroids: Cushing's Syndrome - hyperglycemia, hyperlipidemia, sodium and water retention, hypertension due to increased sensitivity to catecholamines, labile mood, striae (stretch marks), muscle atrophy, bruising and echymoses due to decreased protein stores. Increased susceptibility to infections; lipogenesis in certain areas (abdomen/waist, face [moon face], upper back [buffalo pump], masked signs of infection due to anti-inflammatory effects of glucocorticoids

-Avoid grapefruit and grapefruit juice decreases drug metabolism, may result in toxicity of the drug

-Should take in moring to simulate normal cortisone release by body

-Need to wean patients off steroids gradually or may cause acute adrenal crisis.

-sone

Corticosteroid

ex. betamethasone (Celestone), cortisone (Cortone Acetate), dexamethasone (Decadron), prednisone

-General Adverse effects for all Corticosteroids: Cushing's Syndrome - hyperglycemia, hyperlipidemia, sodium and water retention, hypertension due to increased sensitivity to catecholamines, labile mood, striae (stretch marks), muscle atrophy, bruising and echymoses due to decreased protein stores. Increased susceptibility to infections; lipogenesis in certain areas (abdomen/waist, face [moon face], upper back [buffalo pump], masked signs of infection due to anti-inflammatory effects of glucocorticoids

-Avoid grapefruit and grapefruit juice decreases drug metabolism, may result in toxicity of the drug

-Should take in moring to simulate normal cortisone release by body

-Need to wean patients off steroids gradually or may cause acute adrenal crisis.

-tretin

Dermatologic agent - Retinoid/ Vitamin A

ex.acitretin, alitretinoin, isotretinoin, tretinoin

- Used topically for skin lesions such as acne, psoriasis, Kaposi's sarcoma lesions

-Watch for increased skin irritation - redness, blistering, rash

-Acitretin (given for psoriasis) also tetratogenic - contraindicated in females with potential of pregnancy in the next 3 years

-lamide

Diuretics -- Carbonic anhydrase inhibitors

ex.acetazolamide, brinzolamide, dorzolamide, methazolamide

- Used to treat glaucoma (decreases edema in the eye) and metabolic alkalosis (causes increased bicarbonate excretion).

-NOT usually a 1st line diuretic for treating fluid overload.

- Water for development of metabolic acidosis.

-semide

Diuretics - Loop diuretic

ex.furosemide, torsemide

- Block sodium, potassium, chloride, and water reabsorption in ascending Loop of Henle

- HYPO (Deficit) - kalemia, calcemia, magnesemia, natremia, tension, chloremia, academia (alkalosis)

- HYPER (Excess) - glycemia, uricemia.

- Ototoxicity and syncope if give too fast IV

-thiazide

Diuretics -- Potassium- losing

ex. chlorthiazide ( Hygroton, Diuril),

hydrochlorothiazide* (Hydrodiuril)

-Inhibits sodium, chloride, and water reabsorption in end portion of ascending LOH and distal tubule

-Vasodilator in addition to diuretic - 1st line drug for treatment of HTN

-Tends to raise blood sugar levels

- Should not give if patient has sulfa allergy; thiazides have sulfa in them

- SE similar to loop diuretics above EXCEPT calcium tends to be high and

ototoxcity is not a problem with thiazide diuretics

-actone

Diuretics -- Potassium- sparing

ex.aldactone, spironolactone

- Blocks effects of aldosterone - decreased sodium/chloride/water reabsorption (therefore increased excretion, and increased potassium reabsorption (thus hyperkalemia a potential problem)

-trel

Female hormone - Progestin

ex.desogestrel, etonogestrel, levonorgestrel, norgestrel

- Used in hormonal contraception

-stim

Hematopoietic agent - colony stimulating factor

ex. filgrastim, pegfilgrastim, sargramostim

- Used to off-set the bone marrow suppressive effects of cancer chemotherapy, radiation, and other treatments

- Side Effects include Flu-Like Symptoms - Fever, Chills, Aches, Pains, Malaise, Fatigue, Nausea, Anorexia

-glinide, ide

Hypoglycemic agents - Secretogues

ex. glipizide (glucotrol), glyburide* (Micronase, DiaBeta), nateglinide (Starlix), repaglinide (Prandin)

- Increase insulin secretion by pancreatic beta cells

- Watch for hypoglycemic reactions

Sulfonylureas (glyburide, glipizide)

-> cause weight gain. Glyburide increasessensitivity to sun.

-glitazone

Hypoglycemic Agents -- Thiazolidinediones

ex.Pioglitazone* (Actos),

Rosiglitazone (Avandia)

- Insulin sensitizers -- Increase insulin uptake and effectiveness by skeletal muscle cells and adipose tissues

-limus

immunosuppressant

ex. Pimecrolimus (Elidel), sirolimus (Rapamune), tacrolimus (Prograf)

- Used in preventing or treating organ rejection

- As with all immunosuppressants - risk of infection, carcinogenesis

-Should not receive immunizations while on these meds

-mab, -monab

immunotherapy -- Monoclonal antibody (MAB)

ex. adalimumab (Humira) alemtuzumab (Campath), Daclizumab (Zenapax), infliximab (Remicade), muromonab-CD3 (Orthoclone OKT3) omalizumab, trastuzumab (Herceptin)

- Used for treatment or prevention of organ rejection or graft vs. host disease; also for management of autoimmune disorders (e.g., rheumatoid arthritis, nephritic syndrome in children)

- Alemtuzumab and transtuzumab and other MABs used to inhibit cell proliferation in some types of cancers

- Adalimumab (Humira), Etanercept (Enbrel), golimumab (Simponi) are anti- Tumor Necrosis Factor MABs, used in treatment of rheumatoid arthritis

-MABs may cause flu-like sx - aches, pain, fever, nausea

-zoline

Nasal decongestants

ex. oxymetazoline, zylometazoline

-These drugs are alpha adrenergic agonists - exert decongestant effect by causing vasoconstriction of nasal blood vessels.

- Can enter systemic circulation and produce SNS effects - tachycardia, hypertension

-nium

Neuromuscular blocking agents

ex. pancuronium

- Used for skeletal muscle relaxation during surgery or other procedures, or for mechanically ventilated patients to avoid "bucking" (resisting) the ventilator's effects.

- Only given to patients on mechanical ventilation - otherwise patient will have a respiratory arrest because cannot initiate own breaths

- Additive/sedative effects with opioids, sedatives, anesthetics

-curium

Neuromuscular blocking agents -- Muscle-relaxant

ex. atracurium, mivacurium

- See above info for pancuronium

- Many drug interactions affecting potency

-coxib

Non-steroidal anti- inflammatory drug (NSAIDs) - Cyclooxygenase-2 (COX- 2) selective inhibitor

ex.valdecoxib (Bextra), celecoxib (Celebrex), rofecoxib (Vioxx)

- Because this class of NSAIDs does not block the COX-1 pathway, it exerts an anti- inflammatory effect without the common side effects of GI irritation/ulcers, bleeding, and Nephrotoxicity. However, because selective COX-2 inhibitors do not have the anti-platelet effect of other NSAIDs, there is an increased risk of thrombi and emboli formation - leading to higher risk of stroke, myocardial infarction, pulmonary embolus, and deep vein thrombosis. Contraindicated in patients at high risk for these problems.

-fenac, -lac

Non-steroidal anti- inflammatory drug (NSAIDs)

ex. diclofenac (Cataflam, Voltaren), etodolac (Lodine), nepafenac, ketrolac (Toradol)

- Therapeutic Effects of all NSAIDS: Analgesic, antipyretic, antiinflammatory

- "fenacs" and "lacs" ( e.g., ketorolac) have the most potent analgesic effect, comparable with opioids

-profen

Non-steroidal anti- inflammatory drugs (NSAIDs)

ex.Fenoprofen (Naprofen), ibuprofen (Motrin, Advil), ketoprofen (Actron, Orudis)

-The "profen" NSAIDS have low to intermediate analgesic potency compared to

other NSAIDs

-Side Effects of all NSAIDs: GI irritation/ulcers/bleeding, nephrotoxicity. These

effects occur with combined COX1-COX2 inhibitors (like the "fenac" and "profen" NSAIDS), and are diminished with selective COX2 inhibitors. However selective COX2 inhibitors are associated with increased risk of MI and stroke.

-afil

Phosphodiesterase inhibitors - PDE-5 inhibitors

ex. sildenafil, tadalafil, vardenafil

-Phosphodiesterase inhibitors (PDIs) block 1 or more of the 5 PD enzyme (PDE) subtypes, resulting in increased intracellular cAMP. Overall effect (depending on specific PDE inhibited) is increased cardiac contractility, vasodilation, bronchodilation. Some nonselective PDIs are aminophylline, pentoxifylline, caffeine.

- The "afil" PDIs selectively block PDE-5, found in the corpus cavernosum of the penis. These drugs are given to treat erectile dysfunction

-rinone

Phosphodiesterase inhibitors - PDE-3 inhibitors

ex. amrinone, milrinone

- The "rinone" PDIs are classified as cardiovascular bipyridines and block PDE3.

- Overall effect is increased cardiac contractility (positive inotropic effect) and vasodilation (decreased afterload), making these drugs useful in treatment of acute congestive heart failure and cardiogenic shock.

-zepam

Sedatives /Anxiolytics -- Benzodiazepine

ex. clonazepam, diazepam (Valium), flurazepam, lorazepam (Ativan), temazepam

-Act on BZD receptors on chloride channel - increase chloride influx into neuronal cells - decrease excitability

- Used as anti-anxiety agent, sedative, anti-convulsant. First-line drug for stopping seizure in progress in status epilepticus

- CNS depressant - everything slows down neurologically. Produces temporary amnesia, which makes BDZ drugs useful as pre-procedural meds

- Elderly especially sensitive to these drugs -> increased risk of falls

-zolam

Sedatives /Anxiolytics -- Benzodiazepine

ex.alprazolam* (Xanax), estazolam, midazolam (Versed), oxazepam (Serax)

- Same as for the "zepam" drugs above.

- Alprazolam (Xanax) not appropriate for elderly

- Midazolam (Versed) - causes amnesia

-barbital

Sedatives /Hypnotics -- Barbituarates

ex.mephobarbital (Mebaral), pentobarbital (Nembutal), phenobarbital (Luminal, Solfoton)

- CNS depressant - everything slows down neurologically

-ase, plase

Thrombolytics

ex. alteplase (Activase), streptokinase (Streptase), reteplase (Retavase)

- Thrombolytics are used to dissolve existing clots

-ANTIDOTE: Amicar (Aminocaproic acid) (Remember - antidote for warfarin

[coumadin] is Vitamin K; antidote for heparin is protamine)

- Watch for and prevent bleeding

- Watch for reperfusion arrhythmias if administered for myocardial infarction

=Streptokinase - contraindicated if strep infections or previous streptokinase in

the last 6 months - high risk of anaphylactic reaction

- Alteplase (Activase) - used in treatment of acute ischemic stroke in adults -needs to be started within 3 hours of the onset of symptoms

-calci

Vitamins & Minerals -- Calcium & Vitamin D supplements

-calciferol, calcitrol, ergocalciferol

-Overdose can have neurological depressant effect - bradyrhythmias, hyporeflexia, bradypnea, decreased alertness and cognition

- Long-term calcium therapy may increase risk of atherosclerosis and acute cardiac effects

-urin, -uric

urine

-allopurinol (*pure+urine)