NRS 325 - MQ 2 MEDICATIONS

Amoxicillin (penicillin-type)

MOA

• Beta-lactam antibiotic

• Inhibits bacterial cell wall synthesis

• “penicillin = puncture bacterial walls“

Uses

• Ear, nose, throat infections

• Sinusitis

• Lower respiratory infections

• UTIs

• Skin infections

• H. pylori treatment

Side Effects

• GI upset (N/V/D)

• Rash

• Allergic reactions/anaphylaxis

• C. diff infection

• Superinfection (thrush)

Cefaclor (cephalosporin)

MOA

• Inhibits bacterial cell wall synthesis

• “cephalosporin = cell wall killer“

Uses

• Respiratory infections

• Skin infections

• Bone/joint infections

• GU infections

• Pneumonia

Side Effects

• Respiratory infections

• Skin infections

• Bone/joint infections

• GU infections

• Pneumonia

Erythromycin (macrolides)

MOA

• Binds 50S ribosome

• Inhibits bacterial protein synthesis

• macrolides = 50S blocker

Uses

• Gram-positive infections

• Respiratory infections

• Penicillin-allergic patients

Side Effects

• Nausea, vomiting, diarrhea

• QT prolongation

• Ventricular arrhythmias

• Hearing loss

• C. diff

Trimethoprim-Sulfamethoxazole (TMP-SMX)

MOA

• Inhibits folic acid synthesis

• Prevents bacterial growth and replication

Uses

• UTIs

• MRSA skin infections

• Pneumocystis jirovecii pneumonia (PJP)

• Gram-positive and gram-negative infections

Side Effects

• Rash

• Stevens-Johnson Syndrome

• Hyperkalemia

• Hypoglycemia

• Crystalluria

• C. diff

• “sulfa = sun sensitivity and Stevens-Johnson“

Ciprofloxacin

MOA

• Inhibits DNA gyrase and Topoisomerase IV

• Stops bacterial DNA replication

Uses

• UTIs

• GI infections

• Respiratory infections

• Anthrax exposure

• Plague

Side effects

• Tendon rupture; “flox = tendon problems“

• Peripheral neuropathy

• QT prolongation

• Dysglycemia

• C. diff

Gentamicin

MOA

• Binds 30S ribosome

• Inhibits bacterial protein synthesis

Uses

• Sepsis

• Meningitis

• Complicated UTIs

• Serious gram-negative infections

Side effects

• ⚠ Nephrotoxicity (kidneys)

• ⚠ Ototoxicity (ears)

• Neuromuscular blockade

• Hypotension

tetracycline

MOA

• Binds 30S ribosome

• Inhibits protein synthesis

Uses

• Lyme disease

• Cholera

• Acne

• Atypical infections

• Tick-borne diseases

Side effects

• Photosensitivity

• Tooth discoloration

• GI upset

• Esophagitis

• Intracranial hypertension

• “tetra = teeth + sunburn“

Metronidazole

MOA

• Damages microbial DNA

• Causes cell death

Uses

• Anaerobic infections

• Bacterial vaginosis

• Trichomoniasis

• Giardia

• C. diff

Side effects

• Metallic taste

• GI upset

• Peripheral neuropathy

• Disulfiram-like reaction with alcohol

• Red-brown urine

Clindamycin

MOA

• Binds 50S ribosome

• Inhibits protein synthesis

Uses

• Skin infections

• Osteomyelitis

• Dental infections

• Anaerobic infections

• MRSA

Side Effects

• Diarrhea

• Rash

• Hepatotoxicity

• ⚠ C. diff colitis

Vancomycin

MOA

• inhibits bacterial cell wall synthesis

Uses

• MRSA

• Endocarditis

• Severe gram-positive infections

• Oral treatment of C. diff

Side effect

• Nephrotoxicity

• Ototoxicity

• Red Man Syndrome

• Hypotension

• Phlebitis

Fluconazole

MOA

• Inhibits ergosterol synthesis

• Disrupts fungal cell membrane

Uses

• Oral thrush

• Vaginal candidiasis

• Systemic candidiasis

• Cryptococcal meningitis

Side effects

• Hepatotoxicity

• QT prolongation

• Nausea

• Rash

• Stevens-Johnson Syndrome

• “azoles = attack ergosterol“

Amphotericin B

MOA

• Binds ergosterol

• Creates pores in fungal membrane

• Fungicidal

Uses

• Severe systemic fungal infections

• Aspergillosis

• Candidiasis

• Cryptococcal meningitis

Side effects

• ⚠ Nephrotoxicity

• Hypokalemia

• Hypomagnesemia

• Infusion reactions

• Fever/chills

Acyclovir

MOA

• Acts as a false nucleoside

• Inhibits viral DNA replication

Uses

• HSV-1

• HSV-2

• Shingles (VZV)

• Chickenpox

Side Effects

• Acute kidney injury

• Neurotoxicity

• Nausea/vomiting

• Headache

• Phlebitis (IV)

Nirsevimab

MOA

• Monoclonal antibody against RSV F protein

• Prevents RSV entry into cells

• Passive immunity

Uses

• RSV prevention in infants and high-risk children

Side effects

• Injection-site reactions

• Rash

• Hypersensitivity

• Rare anaphylaxis

Amlodipine

MOA

• calcium channel blocker

• Blocks calcium entry into vascular smooth muscle and myocardium

• Causes peripheral and coronary vasodilation

• Decreases peripheral vascular resistance and BP

Uses

• Hypertension

• Chronic stable angina

• Vasospastic (Prinzmetal) angina

Major Adverse Effects

• Hypotension

• Headache

• Dizziness

• Peripheral edema

• flushing

• gingival hyperplasia

• “amlodipine = ankle edema“

Metoprolol

MOA

• Selectively blocks beta-1 receptors

• Slows heart rate

• Decreases cardiac contractility

• Reduces myocardial oxygen demand

Uses

• Hypertension

• Myocardial infarction

• Tachycardias

• Angina

• Heart failure

• Dysrhythmias

Major Adverse Effects

• Bradycardia

• Hypotension

• Dizziness

• Fatigue

• Bronchoconstriction

• Heart block

• Sxual dysfunction

Propranolol

MOA

• Blocks beta-1 and beta-2 receptors

• Decreases HR and contractility

• Reduces BP and myocardial oxygen demand

Uses

• Hypertension

• Angina

• Dysrhythmias

• MI prevention

• Migraines

• Essential tremor

• Hyperthyroidism

Major Adverse Effects

• Bradycardia

• Hypotension

• Bronchospasm

• Fatigue

• Depression

• Masks hypoglycemia

• “protects the heart but problems asthma“

Nitroglycerin

MOA

• nitrate

• Vasodilates veins and arteries

• Decreases preload

• Decreases myocardial oxygen demand

• Improves coronary blood flow

Uses

• Stable angina

• Unstable angina

• Acute heart failure

• Hypertensive emergencies

Major Adverse Effects

• Headache + Hypotension !!

• Reflex tachycardia

• Dizziness

• Flushing

Isosorbide

MOA

• long acting nitrate

• Releases nitric oxide

• Venous dilation > arterial dilation

• Decreases preload

• Decreases cardiac workload

Uses

• Long-term angina prevention

• Coronary artery disease

• Heart failure

Major Adverse Effects

• Headache

• Orthostatic hypotension

• Dizziness

• Flushing

• Reflex tachycardia

Adenosine

MOA

• Slows AV node conduction

• Interrupts reentry pathways

• Restores normal sinus rhythm in PSVT

Uses

• Paroxysmal supraventricular tachycardia (PSVT)

• Cardiac stress testing

Major Adverse Effects

• Brief asystole - “pauses the heart to restart it“

• Chest pain

• Flushing

• Dyspnea

• Headache

• Dizziness

Amiodarone

MOA

• class III arrhythmic

• Blocks potassium channels

• Prolongs cardiac action potential

• Decreases AV conduction

• Also affects sodium, calcium, alpha, and beta receptors

Uses

• Ventricular tachycardia

• Ventricular fibrillation

• Life-threatening dysrhythmias

Major Adverse Effects

• Pulmonary fibrosis

• Hepatotoxicity

• Hypothyroidism

• Hyperthyroidism

• Bradycardia

• Hypotension

• Blue-gray skin discoloration

• “affects almost every organ“

Diltiazem

MOA

• Calcium channel blocker, class IV arrhythmic

• Slows AV node conduction

• Decreases heart rate !!

• Vasodilates coronary arteries

Uses

• Atrial fibrillation

• Atrial flutter

• SVT

• Angina

• Hypertension

Major Adverse Effects

• Bradycardia

• Hypotension

• Heart failure

• Peripheral edema

• Constipation

• Hepatotoxicity

Lidocaine

MOA

• Blocks sodium channels, class Ib antiarrhythmic

• Stabilizes cardiac membranes

• Suppresses ventricular automaticity

Uses

• Ventricular tachycardia

• Ventricular ectopy

• Post-MI ventricular dysrhythmias

• Local anesthesia

Major Adverse Effects

• Confusion

• Seizures

• Bradycardia

• Hypotension

• Heart block

• Cardiac arrest (toxicity)

• “puts a lid on ventricular irritability”

Atropine

MOA

• Blocks acetylcholine at muscarinic receptors; anticholinergic

• Inhibits parasympathetic stimulation

• Increases SA and AV node conduction

• Increases heart rate

Uses

• Symptomatic bradycardia

• Organophosphate poisoning

• Cholinergic toxicity

• Reduce surgical secretions

Major Adverse Effects

• Dry mouth

• Urinary retention

• Constipation

• Blurred vision

• Tachycardia

• Confusion/delirium

• “no see, no pee, no spit, no poop = anticholinergic effects“

Hydrochlorothiazide (HCTZ)

MOA: Inhibits sodium reabsorption in the distal tubule, increasing excretion of sodium, water, potassium, and hydrogen ions.

Therapeutic Uses: Hypertension, edema associated with heart failure, cirrhosis, nephrotic syndrome, and renal disease.

Key Side Effects: Hypokalemia, hyponatremia, dehydration, hypotension, metabolic alkalosis, hyperglycemia, hyperuricemia, photosensitivity.

Memory Trick: "Thiazides drain K+" → Think low potassium.

Lisinopril

MOA: ACE inhibitor; blocks conversion of angiotensin I to angiotensin II, causing vasodilation and reduced blood pressure.

Therapeutic Uses: Hypertension, heart failure, STEMI, chronic kidney disease.

Key Side Effects: Dry cough, hyperkalemia, hypotension, dizziness, angioedema.

Memory Trick: "LISINOPRIL = Listen for a cough."

Losartan

MOA: ARB; blocks angiotensin II receptors, preventing vasoconstriction and aldosterone secretion.

Therapeutic Uses: Hypertension, heart failure, diabetic nephropathy.

Key Side Effects: Hyperkalemia, hypotension, dizziness, syncope, edema.

Memory Trick: ARB = Avoids the ACE cough but still raises K+.

Lovastatin

MOA: Inhibits HMG-CoA reductase, decreasing hepatic cholesterol synthesis.

Therapeutic Uses: Hyperlipidemia, prevention of coronary artery disease.

Key Side Effects: Myopathy, rhabdomyolysis, hepatotoxicity, abdominal pain, nausea, diarrhea.

Memory Trick: Statins = "Sore muscles, Sick liver."

Clopidogrel

MOA:

Irreversibly blocks P2Y12 (ADP) receptors on platelets, reducing platelet aggregation.

Therapeutic Uses:

• Acute coronary syndrome

• prevention of MI and stroke.

Key Side Effects:

• Bleeding

• bruising,

• TTP,

• hypersensitivity reactions.

Memory Trick: "clops" platelets from sticking together.

Heparin

MOA: Enhances antithrombin III activity, inactivating thrombin and factor Xa.

Therapeutic Uses: Prevention and treatment of DVT, PE, and thromboembolic disorders.

Key Side Effects: Bleeding, HIT (heparin-induced thrombocytopenia).

Memory Trick: Heparin = HIT + Hemorrhage.

Antidote: Protamine sulfate

Enoxaparin (Lovenox)

MOA: Low molecular weight heparin that primarily inhibits factor Xa.

Therapeutic Uses: DVT prophylaxis/treatment, ACS, thromboembolism prevention.

Key Side Effects: Bleeding, HIT, spinal hematoma, anemia, hyperkalemia.

Memory Trick: Lovenox = Low-molecular-weight Xa blocker.

Antidote: Protamine sulfate

Apixaban (Eliquis)

MOA: Direct factor Xa inhibitor.

Therapeutic Uses: Prevention of stroke in atrial fibrillation, treatment/prevention of DVT and PE.

Key Side Effects: Bleeding, anemia, nausea, spinal hematoma.

Memory Trick: Xa-ban = Factor Xa BAN.

Antidote: Andexanet alfa

Warfarin

MOA: Inhibits synthesis of vitamin K-dependent clotting factors II, VII, IX, and X.

Therapeutic Uses: Prevention of DVT, PE, stroke in AFib, valve replacement-associated thrombosis.

Key Side Effects: Bleeding, skin necrosis, purple toe syndrome, GI upset.

Memory Trick: Warfarin "wars" against Vitamin K.

Antidote: Vitamin K

Alteplase (tPA)

MOA: Converts plasminogen to plasmin, which dissolves fibrin clots.

Therapeutic Uses: Acute ischemic stroke, STEMI, massive PE.

Key Side Effects: Bleeding, intracranial hemorrhage, hypotension, angioedema.

Memory Trick: tPA = Tissue Plasminogen Activator = Tears Apart clots.

Vitamin K

MOA: Promotes production of vitamin K-dependent clotting factors.

Therapeutic Uses: Reversal of warfarin, vitamin K deficiency bleeding, elevated INR.

Key Side Effects: Flushing, injection site pain, hypotension, anaphylaxis (rare).

Memory Trick: Vitamin K = "Korrects" Warfarin.

Tranexamic Acid (TXA)

MOA: Prevents conversion of plasminogen to plasmin, stabilizing formed clots.

Therapeutic Uses: Trauma hemorrhage, postpartum hemorrhage, menorrhagia, surgical bleeding.

Key Side Effects: Nausea, vomiting, headache, DVT, PE, stroke, seizures.

Memory Trick: TXA = "Trap the clot."

Norepinephrine

MOA: Alpha-1 and beta-1 agonist causing vasoconstriction and increased cardiac contractility.

Therapeutic Uses: Septic shock, cardiogenic shock, severe hypotension.

Key Side Effects: Bradycardia, arrhythmias, tissue ischemia, extravasation injury.

Memory Trick: Levophed = "Leave no pressure low."

Phenylephrine

MOA: Selective alpha-1 agonist causing vasoconstriction and increased blood pressure.

Therapeutic Uses: Hypotension, vasopressor support, nasal congestion.

Key Side Effects: Reflex bradycardia, hypertension, headache, tissue ischemia.

Memory Trick: Phenyl = Pure alpha-1.

Ferrous Sulfate

MOA: Replaces iron stores needed for hemoglobin production.

Therapeutic Uses: Treatment and prevention of iron-deficiency anemia.

Key Side Effects: Constipation, nausea, abdominal pain, heartburn, dark stools.

Memory Trick: Iron = Black stools + Constipation.