drugs pt 1 coast

only unique ADR's included

Vecuronium

MOA: blocks Nm receptors at NMJs resulting in SKM paralysis

Use: Surgery to produce SKM relaxation

ADR: produces significant Nn blockade (ganglionic), releases histamine from mast cells —> allergic reactions

Other: can be reversed by anti-ChE

succinylcholine

MOA: Nm receptor agonist —> persistant depolarization —> depolarization blockade

Use: surgery to produce SKM relaxation

ADR:

• Hyperkalemia in patients taking digoxin or K+ sparing drugs, or with tissue injuries/burns

• Malignant hyperthermia in susceptible pt

Other: rapid onset and hydrolysis by BuChE —> short duration of action

• Do not take with anti-ChE

Bethanechol

MOA: mAChR choline ester agonist

Use: urinary retention (pt with neurogenic bladder), ileus (postoperative bowel/stomach paralysis)

ADR:

Other: CI in asthma/COPD, urinary tract/GI obstruction

Atropine

MOA: muscarinic antagonist

Use: bradycardia, AV block (acute mI),

• Tox: used to treat mycetism (mushroom poisoning) and anti-ChE tox

ADR: confusion, drowsiness and other sympathetic effects

Other: CI in pt w glaucoma, urinary/gastric retention, GI obstruction

Oxybutynin

MOA: mAChR antagonist

Use: overactive bladder, neurogenic bladder, bed wetting

Ipatropium

MOA: anti-mAChR

Use: COPD, asthma, rinorrhea due to allergic or non-allergic rhinitis

Pyridostigmine

MOA: Carbamioylating anti-ChE (-stigmine)

Use: reversal of neuromuscular blockade produced by competitive (but not depolarizing) Nm antagnoists, myasthenia gravis

Other: pupillary constriction may impair peripheral vision in low light

methyldopa

MOA: alpha2 agonist (main) and prodrug pretending it is dopamine and converted to methylNE, which replaces some of the NE in synaptic vesicles (sympatholytic)

Use: HTN

ADR: drowsiness, xerostomia or dry mouth

Other: alpah 2 agonist activity of methylNE results in anti-HTN effects

amphetamine

MOA: amphetamine like indirect sympathomimetic, taken into adrenergic nerve terminals via NET and into synaptic vesicles via VMAT, displacing NE which is excreted into junctional space via reverse NETs

Use: ADHD, narcolepsy

ADR: cardiac arrhythmias, insomnia, nervousness (esp. if taken with ephedrine)

Other: also inhibits DAT, NET, and SERT; drug of abuse

NE

MOA: endogenous catecholamine as drug; stimulates alpha 1, alpha 2, and beta 1receptors

Use: acute hypotension, shock due to hypotension

ADR: inc HR, cardiac arrhythmias

Other: BRR mediated reflex bradycardia is more common than tachycardia

EPI

MOA: endogenous catecholamine as drug; stimulates alpha 1, alpha 2, beta 1 and beta 2 receptors

Use: acute anaphylactic reactions, cardiac arrest (to maintain BP), local anesthesia (dec. blood flow to anesthetized area)

Other: drug epi is given at high doses and results in alpha 1 vasoconstrictive effects to outweigh beta 2 mediated vasodilation; this is unlike physiological epi

clonidine

MOA: stimulates alpha 2 receptors

Use: HTN

ADR: drowsiness, xerostomia

Other: anti-HTN effects primarily due to stimulation of alpha 2 receptors

phentolamine

MOA: alpha receptor antagonist

Use: pheochromocytoma (tumor in adrenal medulla resulting in excess secretion of NE, EPI)

ADR: orthostatic hypotension with reflex tachycardia

prazosin

MOA: alpha 1 selective antagonist (-osins)

Use: HTN, BPH

ADR: orthostatic hypotension w reflex tachycardia

Other: less reflex tachycardia than with nonselective alpha antagonists

isoproteronol

MOA: stimulates beta receptors

Use: extreme bradycardia, AV block

ADR: tachycardia, cardiac arrhythmias, angina pectoris (especially in pt with underlying cardiac disease)

Other: use only in emergencies

dobutamine

MOA: beta 1 selective agonist

Use: acute HF, cardiogenic shock

ADR: tachycardia, cardiac arrhythmias

Other: increases inotropic state more than HR, beta 1 selectivity is apparent —> dobutamine has counter-balancing effects on vascular SM (alpha 1 vasoconstriction, beta 2 vasodilation) `

albuterol

MOA: beta 2 selective agonist (-terols)

Use: asthma/COPD

ADR: tremor due to stimulation of beta 2 receptors on SKM, CNS effects of anxiety, apprehension, and cardiac stimulation (not 100% selective for beta 2 receptors)

Other: administration by inhalation minimizes systemic adverse effects

propanolol

MOA: nonselective beta antagonist

Use: angina pectoris, MI, HFrEF, cardiac arrhythmias that can be treated or terminated by decreasing AV conduction (AVNRT, control of ventricular rate in atrial fibrillation), cardiac arrhythmias that are caused or aggravated by sympathetic stimulation of herat (VPCs), HTN, glaucoma, essential tremor, performance anxiety, migraine prophylaxis

ADR: HF, bradycardia, AV block, asthma/COPD exacerbation, risk of hypoglycemic episodes in pt with diabetes mellitus, risk of angina pectoris/MI/cardiac arrhythmias and sudden death following arupt discontinuation after chronic use especially in pt with underlying coronary disease, vivid dreams, fatigue, drowsines, sexual dysfunction

Other: CI in acute HF, bradycardia, AV block, and asthma

• AVOID in pt with coronary vasospasm angina

metoprolol

beta 1 selective antagonist

atenolol

beta 1 selective antagonist

carvedilol

beta receptor antagonist with additional CV effects (vasodilation)

enalapril

MOA: ACEi (-prils)

Use: HTN, HFrEF, MI, diabetic and non-diabetic CKD with proteinuria

ADR: dry cough, angioedema (rare), hypotension, hyperkalemia

Other: CI pregnancy, many ACEis are prodrugs

aliskiren

MOA: direct renin inhibitor

Use: HTN

ADR: mild adverse GI effects, hyperkalemia,

Other: CI pregnancy

Losartan

MOA: AT1 receptor antagonist (-sartans)

Use: HTN (first line), HFrEF, MI, diabetic and non-diabetic CKD w proteinuria

ADR: hypotension, hyperkalemia

Other: CI pregnancy, possibility of nitrosamine contaminants in selected ARBs

amlodipine

MOA: DHP calcium channel blocker (-dipines)

Use: angina pectoris, HTN, pulmonary HTN

ADR: hypotension, headache, flushing, peripheral edema

Other: DHP CCBs are more potent vasodilators; limited efficacy for peripheral edema

verapamil

MOA: non-DHP CCB

Use: nagina pectoris, HTN, cardiac arrhythmias that can be terminated by dec. AV conduction (AVNRT)

ADR: constipation, sinus bradycardia, AV block, HF

nitroglycerin

MOA: release nO which then activates GC in vascular SM resulting in vasodilation

Use: angina pectoris (acute and chronic), HTN emergencies, acute MI, acute hF

ADR: headache, flushing, hypotension, orthostatic hypotension, reflex tachycardia, RAPID tolerance (12-14 hour nitrate-free interval daily)

Other: SL, oral capsules, ER tabs, SL spray, ointment, patch, IV sol.

nitroprusside

MOA: inorganic nitrate

Use: HTN emergencies, acute HF, production of controlled hypotension during surgery

ADR: hypotension, cyanide tox

Other: IV admin only

sildenafil

MOA: PDE5 inhibitor (blocks PDE in SM, inc. cGMP and PKG activity —> relaxation)

Use: erectile dysfunction, pulmonary HTN

ADR: headache, flushing, dyspepsia, back pain, myalgia, vision loss, changes in blue-green color discrimination, hearing loss

Other: CI in pt w organic nitrates, use in caution w pt taking alpha 1 antagonists for HTN or BPH

digoxin

MOA: inhibits Na+-K+ ATP increasing parasympathetic and decreasing sympathetic tone in heart, decreasing AV conduction, increased IS

Use: HFrEF, cardiac arrhythmias that can be treated or terminated by decreased AV conduction (AVNRT)

ADR: AV block, ventricular arrhythmias, adverse GI effects (n/v/anorexia)

Other: very low therapeutic index

aspirin

MOA: NSAIDs; low dose inhibits COX 1 resulting in antipyretic, analgesic, and inflammatory effects (high dose inhibits cox 2),

Use: mild to severe pain, fever, osteoarthritis, rheumatoid arthritis, dysmenorrhea, migraine, secondary prevention of CV disease events

ADR: adverse GI effects (ulcers, nausea), bad for kidney dysfunction, prolonged bleeding, premature closer of ductus arterious if taken 30 + weeks gestation, allergic rxns

Other: aspirin is an irreversible inhibitor

ibuprofen

MOA: NSAIDs

Use: mild to severe pain, fever, osteoarthritis, rheumatoid arthritis, dysmenorrhea, migraine

ADR: adverse GI effects (ulcers, nausea), bad for kidney dysfunction, prolonged bleeding, premature closer of ductus arterious if taken 30 + weeks gestation, allergic rxns

celecoxib

MOA: selective COX-2 inhibitor (-coxibs)

Use: moderat- to severe pain, osteoarthritis, rheumatoid arthritis

ADR: adverse GI effects (ulcers, nausea), bad for kidney dysfunction, prolonged bleeding, premature closer of ductus arterious if taken 30 + weeks gestation, allergic rxns

Other: higher MI risk

adenosine

vasodilatory endogenous nucleoside

use for Arrhythmias that can be terminated by slowing AV conduction

phenylephrine

alpha 1 agonist

Nasal congestion, ophthalmological examination