Pharmacology 1 Final Exam Drug List

Glycopyrrolate

MOA: Muscarinic antagonist
Use: Reduce salivary gland activity
Side Effect: Potential for antimuscarinic (anticholinergic) side effects

Pralidoxime

MOA: Binds to cholinesterase (kicks off phosphate from organophosphate), reactivating cholinesterase
Use: Treatment for organophosphate poisoning
Side Effect: None notable

Bethanechol

MOA: Muscarinic agonist
Use: Acts on bladder to treat urinary retention
Side Effect: None notable

Oxybutynin

MOA: Muscarinic antagonist
Use: Reduce overactive bladder
Side Effect: Potential for antimuscarinic (anticholinergic) side effects

Edrophonium

MOA: Acetylcholinesterase inhibitor that acts primarily on skeletal muscle
Use: Treatment and diagnostic test for myasthenia gravis; reversal agent for non-depolarizing neuromuscular blockers
Side Effect: Cholinergic side effects when given in excess (too much ACh)

Donepezil

MOA: Acetylcholinesterase inhibitor that acts primarily in the CNS
Use: Alzheimer's disease
Side Effect: Cholinergic side effects

Atropine

MOA: Muscarinic antagonist at muscarinic receptors in the heart and other target organs
Use: Treatment for bradycardia; treats parasympathetic symptoms of organophosphate poisoning
Side Effect: Anticholinergic side effects

Pancuronium

MOA: Non-depolarizing neuromuscular blocker (competitive antagonist at nicotinic receptors)
Use: Skeletal muscle relaxation during surgery or mechanical ventilation
Side Effect: Effects can be reversed by acetylcholinesterase inhibitors

Succinylcholine

MOA: Depolarizing neuromuscular blocker at nicotinic receptors (agonist causing persistent depolarization leading to paralysis)
Use: Skeletal muscle relaxation during surgery or mechanical ventilation
Side Effect: Effects cannot be reversed by acetylcholinesterase inhibitors

Norepinephrine

MOA: Alpha-1 agonist
Use: Hypotension and shock; hypotension not responsive to dopamine
Side Effect: None notable

Albuterol

MOA: Beta-2 agonist
Use: Asthma
Side Effect: Short-acting

Salmeterol

MOA: Beta-2 agonist
Use: Asthma
Side Effect: Long-acting

Clonidine

MOA: Activation of alpha-2 receptors in the CNS, decreasing sympathetic outflow to heart and vascular smooth muscle
Use: Hypertension, anxiety
Side Effect: None notable

Phenoxybenzamine

MOA: Non-competitive alpha-1 and alpha-2 antagonist
Use: Hypertension in pheochromocytoma
Side Effect: None notable

Phentolamine

MOA: Competitive alpha-1 and alpha-2 antagonist
Use: Hypertension in pheochromocytoma
Side Effect: Causes reflex tachycardia due to blockade of presynaptic alpha-2 receptors

Metoprolol

MOA: Beta-1 blocker
Use: Hypertension, angina, acute myocardial infarction
Side Effect: None notable

Carvedilol

MOA: Beta and alpha antagonist
Use: Hypertension/heart failure
Side Effect: Has antioxidant properties; improves symptoms and mortality in heart failure

Labetalol

MOA: Beta and alpha antagonist
Use: Hypertension
Side Effect: None notable

Hydrochlorothiazide

MOA: Thiazide diuretic; inhibits Na/Cl symporter
Use: Hypertension, edema associated with heart failure
Side Effect: Hypokalemia, can increase uric acid and plasma calcium

Propranolol

MOA: Beta-1 and Beta-2 blocker (non-selective)
Use: Hypertension, angina
Side Effect: Can potentially cause bronchospasm if administered with Beta-2 agonist

Lisinopril

MOA: ACE inhibitor; inhibits formation of angiotensin II
Use: Hypertension, heart failure, diabetic nephropathy
Side Effect: Cough, angioedema, hyperkalemia; first-line treatment for hypertension in patients under 55 (except African/Caribbean origin who benefit from CCB)

Losartan

MOA: Prevents angiotensin II from binding to AT1 receptor on blood vessels
Use: Hypertension, heart failure, diabetic nephropathy
Side Effect: Hyperkalemia

Amlodipine

MOA: Dihydropyridine calcium channel blocker; blocks calcium channels in vascular and cardiac smooth muscle (greater effect on peripheral smooth muscle)
Use: Hypertension, angina
Side Effect: First-line treatment in hypertension in patients over 55 or African/Caribbean origin at any age; can cause reflex tachycardia

Diltiazem

MOA: Non-dihydropyridine calcium channel blocker; slows SA node automaticity, decreases AV node conduction velocity
Use: Control rate in atrial fibrillation or atrial flutter, treats angina
Side Effect: None notable

Nifedipine

MOA: Dihydropyridine calcium channel blocker; blocks calcium channels in vascular and cardiac smooth muscle (greater effect on peripheral smooth muscle)
Use: Hypertension, angina
Side Effect: First-line treatment in hypertension in patients over 55 or African/Caribbean origin at any age; can cause reflex tachycardia

Verapamil

MOA: Non-dihydropyridine calcium channel blocker; slows SA node automaticity, decreases AV node conduction velocity
Use: Supraventricular dysrhythmias; control rate in atrial fibrillation or atrial flutter, treats angina
Side Effect: None notable

Hydralazine

MOA: Arterial vasodilator
Use: Moderate to very severe hypertension; heart failure
Side Effect: Can cause reflex tachycardia; can cause hypotension when given IV; Black patients benefit from Hydralazine + nitrate more than ACE in chronic heart failure

Furosemide

MOA: Loop diuretic; inhibits Na/K/2Cl transporter
Use: Hypertension, edema associated with heart failure
Side Effect: Hypokalemia, hyponatremia

Spironolactone

MOA: Aldosterone antagonist in kidneys
Use: Hypertension, severe heart failure
Side Effect: Hyperkalemia; anti-androgenic effects (gynecomastia); evidence improves mortality in severe heart failure

Nitroglycerin

MOA: Releases nitrous oxide in vascular smooth muscle leading to vasodilation, preferentially relaxes venous smooth muscle, reducing cardiac preload
Use: Prevent and treat angina attacks
Side Effect: Can lead to reflex tachycardia (can use beta-blocker to control); pharmacological tolerance can develop (patches should be removed at least 10 hours each day); can be given as patch, topical ointment, sublingually

Isosorbide mononitrate

MOA: Releases nitrous oxide in vascular smooth muscle leading to vasodilation, preferentially relaxes venous smooth muscle, reducing cardiac preload
Use: Prevent and treat angina attacks
Side Effect: Can lead to reflex tachycardia

Digoxin

MOA: Increases intracellular calcium by inhibiting sodium pump (Na+, K+-ATPase); positive inotropic effect, negative chronotropic effect, negative dromotropic effect
Use: Systolic heart failure
Side Effect: Does not improve survival in heart failure but can improve symptoms; need to check therapeutic levels; many drug interactions

Dobutamine

MOA: Beta-1 agonist (increases contractility and heart rate), Beta-2 agonist (peripheral vasodilation, reducing afterload)
Use: Decompensated heart failure and cardiogenic shock
Side Effect: None notable

Enalapril

MOA: ACE inhibitor; reduces effects of angiotensin II cardiac remodeling
Use: Asymptomatic heart failure; helps cardiac function post-MI
Side Effect: Cough, hyperkalemia; decreases mortality in heart failure

Valsartan

MOA: Angiotensin receptor blocker; reduces effects of angiotensin II cardiac remodeling
Use: Asymptomatic heart failure; helps cardiac function post-MI
Side Effect: Hyperkalemia; less likely to get cough than ACE inhibitor

Sacubitril

MOA: Neprilysin inhibitor (inhibits breakdown of natriuretic peptides ANP, BNP); combined with ARB because neprilysin also breaks down angiotensin II
Use: Heart failure with reduced ejection fraction (combination pill ARNI - most common is Entresto with Valsartan)
Side Effect: Hypotension due to increase in natriuretic peptides and RAAS blockade

Amiodarone

MOA: Class 3 antiarrhythmic; blocks potassium channels to delay repolarization and increase refractory period; no effect on phase 0, prolonged phase 3
Use: Antiarrhythmic; good for heart failure patients
Side Effect: Many side effects including pulmonary fibrosis; interacts with Digoxin, Simvastatin, Warfarin (can adjust dosage)

Atorvastatin

MOA: HMG co-reductase inhibitor
Use: Hyperlipidemia
Side Effect: Myopathy, liver dysfunction, rhabdomyolysis; metabolized by CYP system (CYP inhibitors can increase concentration in blood)

Simvastatin

MOA: HMG co-reductase inhibitor (lower potency)
Use: Hyperlipidemia
Side Effect: Myopathy, liver dysfunction, rhabdomyolysis; metabolized by CYP system (CYP inhibitors can increase concentration in blood)

Cosyntropin

MOA: Synthetic formulation of ACTH
Use: Distinguish congenital adrenal hyperplasia from ovarian hyperandrogenism; diagnose adrenal insufficiency
Side Effect: Not used therapeutically, only for diagnostic purposes

Desmopressin

MOA: Long-acting synthetic analog of vasopressin; acts on V1 receptors (vasoconstriction) and V2 receptors (increases water reabsorption via aquaporin channels)
Use: Treatment of nocturnal enuresis; diabetes insipidus; can control bleeding
Side Effect: Use with caution in patients with coronary artery disease

Conivaptan

MOA: Dual vasopressin antagonist at V1 and V2 receptors
Use: Treatment of euvolemic and hypervolemia hyponatremia
Side Effect: None notable

Tolvaptan

MOA: Selective vasopressin antagonist at V2 receptors
Use: Treatment of euvolemic and hypervolemia hyponatremia; treatment of SIADH
Side Effect: None notable

Estradiol

MOA: Most predominant estrogen in the human body
Use: Oral contraception; treatment of primary hypogonadism; hormone replacement therapy in post-menopausal women
Side Effect: Many formulations (transdermal, oral); hypertension; thromboembolic disorders; gallbladder disease; giving estrogen alone as HRT increases risk of endometrial cancer

Drospirenone and Ethinyl Estradiol (Yasmin)

MOA: Progesterone/estrogen combination; estrogen reduces FSH secretion; progesterone inhibits midcycle LH surge for ovulation
Use: Oral contraception; treatment of acne vulgaris; treatment of dysmenorrhea
Side Effect: Available as 21-day or 24-day hormone regimen; estrogen side effects per above; drospirenone is aldosterone antagonist with weak antiandrogenic effect; beware interactions with drugs that increase hepatic metabolism of OCPs

Copper Intrauterine Device (Paragard)

MOA: Alters viability and transport of sperm and ovum; copper damages ovum after fertilization but before implantation
Use: Contraception
Side Effect: Can be used for up to 10 years

Levonorgestrel Intrauterine Device (Mirena)

MOA: Progesterone; prevents pregnancy by producing localized effects on endometrium
Use: Contraception
Side Effect: Can be used for up to 8 years

Levonorgestrel (Plan B)

MOA: Progesterone formulation; prevents fertilization by inhibition of ovulation and thickening of cervical mucous; unlikely to prevent implantation of fertilized egg
Use: Emergency contraception
Side Effect: Nausea and vomiting; first dose taken within 72 hours of intercourse, second dose 12 hours later

Mifepristone

MOA: Glucocorticoid receptor antagonist AND progesterone receptor antagonist; causes endometrial degeneration leading to detachment of blastocyst
Use: Medical termination of pregnancy through 49 days gestation; treatment of Cushing syndrome
Side Effect: Followed by prostaglandin (misoprostol) 48 hours later to stimulate uterine contractions; nausea and vomiting

Methimazole

MOA: Thioamide drug which inhibits thyroperoxidase-catalyzed step in thyroid hormone synthesis
Use: Grave's disease
Side Effect: Maculopapular rash/agranulocytosis; higher risk of birth defects

Propylthiouracil (PTU)

MOA: Thioamide drug which inhibits thyroperoxidase-catalyzed step in thyroid hormone synthesis; inhibits conversion of T4 to T3 in peripheral tissues
Use: Grave's disease
Side Effect: Maculopapular rash/agranulocytosis; drug of choice before pregnancy and for 1st trimester

Potassium Iodide Solution

MOA: Inhibits release of thyroid hormones from thyroid gland
Use: Treats patients with acute thyrotoxicosis; prepares patients for thyroid surgery
Side Effect: None notable

Radioactive sodium Iodide (I-131)

MOA: Emits beta-particles that destroy thyroid tissue
Use: Treatment of Grave's disease
Side Effect: Contraindicated in pregnant women

Prednisone

MOA: Glucocorticoid; some mineralocorticoid activity
Use: Treats autoimmune conditions, inflammation; adjunctive therapy to DMARDs; acute gout treatment
Side Effect: Medium potency; 12-36 hours duration; Cushing syndrome features; hyperglycemia; weight gain

Dexamethasone

MOA: Glucocorticoid
Use: Diagnostic dexamethasone test; treats inflammatory conditions
Side Effect: High potency; 24-72 hours duration; Cushing syndrome features

Glipizide

MOA: Sulfonylurea; increases insulin release from pancreatic beta cells; decreases glucagon secretion
Use: Type 2 diabetes
Side Effect: Weight gain; hypoglycemia

Acarbose

MOA: Competitively inhibits alpha glucosidase (prevents conversion of oligosaccharides and disaccharides to glucose)
Use: Type 2 diabetes
Side Effect: Flatulence and abdominal bloating

Metformin

MOA: Inhibits gluconeogenesis in liver; increases insulin sensitivity in peripheral tissues; enhances glucose uptake in skeletal muscle and adipose tissue
Use: First-line treatment for type 2 diabetes
Side Effect: Diarrhea (switch to extended release); contraindicated in renal or hepatic disease due to potential lactic acidosis

Sitagliptin

MOA: DPP-4 inhibitor (causes increase in GLP-1 levels)
Use: Type 2 diabetes
Side Effect: Not as much weight loss as GLP-1 agonists

Semaglutide (Ozempic)

MOA: GLP-1 agonist; stimulates glucose-dependent insulin secretion and inhibition of glucagon secretion, increases glucose uptake, slows gastric emptying (decreasing appetite and food intake)
Use: Type 2 diabetes
Side Effect: Available for once-weekly injection or daily oral; slightly increased risk of pancreatitis

Empagliflozin

MOA: SGLT2 inhibitor; decreases renal glucose and sodium absorption, increases urinary excretion; leads to decrease in renin and RAAS inhibition
Use: Type 2 diabetes; heart failure (HFrEF, HFmRF, HFpEF); chronic kidney disease (GFR above 20)
Side Effect: Increased incidence of UTIs and genital yeast infections; can cause volume depletion; reduces cardiovascular mortality; improves glycemic control; reduces declines in GFR

Pioglitazone

MOA: Thiazolidinedione; agonist at PPAR-gamma receptor; increases insulin sensitivity by increasing GLUT4 glucose transporters; activates PPAR-alpha to improve lipid levels
Use: Type 2 diabetes
Side Effect: Contraindicated in patients at risk of heart failure or in heart failure patients; causes weight gain

Warfarin

MOA: Inhibits vitamin K reductase (inhibits synthesis of clotting factors 2, 7, 9, 10)
Use: Pulmonary embolism, DVT
Side Effect: Monitored by INR, antidote is Vitamin K, metabolized by CYP2C9; CYP2C9 inhibitors increase Warfarin and bleeding risk; CYP2C9 inducers decrease Warfarin, reducing bleeding risk

Heparin

MOA: Activates antithrombin, inhibits Factor Xa and Factor II (thrombin)
Use: Pulmonary embolism, DVT
Side Effect: Antidote is Protamine, measure efficacy via aPTT; rare effect of HIT (heparin-induced thrombocytopenia)

Enoxaparin

MOA: Activates antithrombin, inhibits Factor Xa and Factor II (thrombin)
Use: DVT prevention in hospital (SubQ injection)
Side Effect: Antidote is Protamine, no routine measurement needed, renally excreted

Dabigatran (Pradaxa)

MOA: Direct thrombin inhibitor
Use: Pulmonary embolism, DVT; prevention of stroke in atrial fibrillation (based on CHADS2VASC score)
Side Effect: Contraindications: active bleeding, mechanical heart valve; renally dosed; reversal agent: Praxbind

Rivaroxaban (Xarelto)

MOA: Direct Factor Xa inhibitor
Use: Pulmonary embolism, DVT; prevention of stroke in atrial fibrillation (based on CHADS2VASC score)
Side Effect: Contraindications: active bleeding, avoid with CYP3A4 inhibitors; renally dosed; reversal agent: Andexxa

Apixaban (Eliquis)

MOA: Direct Factor Xa inhibitor
Use: Pulmonary embolism, DVT; prevention of stroke in atrial fibrillation (based on CHADS2VASC score)
Side Effect: Contraindications: active bleeding, mechanical heart valve; renally dosed; reversal agent: Andexxa

Aspirin

MOA: Inhibition of cyclooxygenase 1 and 2 (prevents making Thromboxane 2, which causes platelet aggregation)
Use: Primary prevention of cardiovascular disease (adults 40-59 with ASCVD risk >10% with low bleeding risk); secondary prevention for MI, stroke/TIA, CABG, PAD
Side Effect: Effects last for duration of platelet (7-10 days)

Clopidogrel

MOA: Blocks ADP from binding to P2Y12 receptor on platelets (prevents platelet activation/aggregation)
Use: Dual therapy for CAD s/p PCI (stents), ACS, high risk after stroke/TIA/CABG
Side Effect: Effects last for duration of platelet (7-10 days)

Alteplase

MOA: Synthetic tPA; converts plasminogen to plasmin, which lyses fibrin
Use: IV infusion to degrade thrombi in MI, thrombotic stroke, or PE
Side Effect: In acute ischemic stroke, must be initiated within 4.5 hours of onset (preferably 3 hours); contraindicated in hemorrhagic stroke

Vitamin K

MOA: Involved in synthesis of clotting factors 2, 7, 9, 10
Use: Antidote to too much Warfarin
Side Effect: Present in many foods such as spinach and kale

Methotrexate

MOA: Multifactorial; reduces purine synthesis; inhibits cytokine production and T/B cell replication; interferes with folic acid metabolism; anti-inflammatory effects
Use: Preferred non-biologic DMARD
Side Effect: Contraindicated in pregnancy/breastfeeding; check CBC, LFTs, creatinine for all non-biologics

Leflunomide

MOA: Inhibits autoimmune T-cell proliferation and production of autoantibodies by B cells
Use: Non-biologic DMARD
Side Effect: Contraindicated in pregnancy/breastfeeding; hepatotoxicity; possibility of Stevens-Johnson syndrome; check CBC, LFTs, creatinine

Sulfasalazine

MOA: Unknown mechanism
Use: Non-biologic DMARD
Side Effect: Pregnancy Category B (probably safe); can get lupus-like reaction; check CBC, LFTs, creatinine

Adalimumab (Humira)

MOA: TNF (tumor necrosis factor) inhibitor
Use: 1st line biologic DMARD
Side Effect: Increased susceptibility to infections; potential for TB reactivation (check PPD before use); increased risk of lymphoma

Rituximab

MOA: Non anti-TNF biologic; eliminates B cells
Use: 2nd line biologic DMARD
Side Effect: Fatal infusion-related reactions; can have Hepatitis B reactivation

Probenecid

MOA: Uricosuric drug; competitively inhibits reabsorption of uric acid by renal tubules (increases renal excretion of uric acid)
Use: Chronic gout
Side Effect: Avoid with salicylates and aspirin

Allopurinol

MOA: Decreases production of uric acid by inhibiting xanthine oxidase
Use: Prevent gout attacks in persons who overproduce uric acid
Side Effect: Nausea and vomiting

Colchicine

MOA: Disrupts microtubules and inhibits motility of inflammatory leukocytes
Use: Treatment of acute gout
Side Effect: Nausea and vomiting

Aspirin for primary prevention of cardiovascular disease

Recommendation: Potentially inappropriate - avoid initiating in elderly patients for primary prevention

Antipsychotics

Recommendation: Potentially inappropriate - increase risk of CVA and worsen cognitive decline; avoid unless danger to self or others

Benzodiazepines

Recommendation: Potentially inappropriate - risk of cognitive effects and injury (falls); avoid

Estrogens

Recommendation: Potentially inappropriate - do not initiate systemic estrogen (vaginal cream/tablets acceptable); risks of blood clots and heart disease outweigh benefits if started at age 60+

Sulfonylureas

Recommendation: Potentially inappropriate - risk of hypoglycemia and higher risk of cardiovascular events than alternatives; avoid

Muscle relaxants

Recommendation: Potentially inappropriate - anticholinergic effects; avoid

Rivaroxaban for treatment of nonvalvular afib or VTE

Recommendation: Potentially inappropriate - higher risk of bleeding in older adults than other DOACs; avoid for long-term treatment

Warfarin for treatment of nonvalvular afib or VTE

Recommendation: Potentially inappropriate - higher risk of bleeding in older adults than other DOACs; avoid for long-term treatment

Drugs to avoid in Delirium

Recommendation: Avoid anticholinergics, antipsychotics, benzodiazepines, corticosteroids, H2 receptor antagonists (antihistamines), opioids (avoid except in situations of high benefit/risk)

Drugs to avoid in Dementia

Recommendation: Avoid anticholinergics, antipsychotics, benzodiazepine