pharm exam 2 drugs

nonselective adrenergic agonist (protype)

epinephrine (Adrenalin)

epinephrine (onset)

immediate to 5 min

epinephrine (duration)

1 - 4 hours

epinephrine (indications)

CPR, anaphylaxis, local vasoconstriction, mydriasis

epinephrine (mechanism of action)

stimulates alpha and beta receptors

epinephrine (routes)

sub-q, IV, IM, inhalation, topical, ophthalmic

epinephrine (adverse effects)

nervousness, tremors, tachycardia, HTN, dysrhythmias, pulmonary edema, CNS stimulation, local necrosis

epinephrine (contraindications)

hypersensitivity, closed angle glaucoma, CAD

epinephrine (pregnancy)

category C

alpha 1 adrenergic agonists (protype)

phenylephrine (neo-synephrine)

phenylephrine (onset)

immediate to 1-2 hours

phenylephrine (duration of action)

15 min - 3 hours

phenylephrine (indications)

nasal congestion, hypotension

phenylephrine (mechanism of action)

activates alpha-1 receptors in the peripheral nervous system

phenylephrine (routes)

PO, sub-q, IM, IV, intranasal, ophthalmic

phenylephrine (adverse effects)

reflex tachycardia, decreased peripheral blood flow, CNS stimulation

phenylephrine (contraindications)

severe HTN, preexisting bradycardia, CAD, narrow angle glaucoma

phenylephrine (pregnancy)

category C

beta adrenergic agonist (protype)

isoproterenol (Isuprel)

isoproterenol (onset)

immediate to varies

isoproterenol (duration of action)

less than 1 hour to 12 hours

isoproterenol (indications)

increased myocardial contraction, transient heart block

isoproterenol (mechanism of action)

activates beta-1 and beta-2 receptors

isoproterenol (routes)

IV, PO, inhalation

isoproterenol (adverse effects)

dysrhythmias, CNS stimulation, headache, nausea, vomitting

isoproterenol (contraindications)

CAD, HTN, dysrhythmias, hyperthyroidism, diabetes

isoproterenol (pregnancy)

category C

thiazide diuretic (protype)

hydrochlorothiazide (Microzide)

hydrochlorothiazide (routes)

PO

hydrochlorothiazide (onset)

2 hrs; peak 4 hrs

hydrochlorothiazide (duration of action)

6-12 hours; half life 45-120 min

hydrochlorothiazide (indications)

HTN, ascites related to edema, heart failure, nephrotic syndrome

hydrochlorothiazide (mechanism of action)

acts on distal tubule to decrease reabsorption of sodium

hydrochlorothiazide (adverse effects)

hypotension, dizziness, headache, electrolyte imbalances, gout, blood dyscrasias

hydrochlorothiazide (contraindications)

hypersensitivity, anuria, jaundiced neonates

hydrochlorothiazide (pregnancy)

category B

loop diuretic (protype)

furosemide (Lasix)

furosemide (route)

PO, IV, IM

furosemide (onset)

PO: 30-60 min IV: 2 hrs IM: 4-8 hrs

furosemide (duration)

PO: 6-8 hrs IV: 2 hrs IM: 4-8 hrs

furosemide (indications)

acute edema, hypertension

furosemide (mechanism of action)

prevents reabsorption of sodium and chloride in loop of henle

furosemide (adverse effects)

orthostatic hypotension, syncope, tachycardia, dysrhythmias, nausea and vomiting, ototoxicity, gout, metabolic alkalosis, electrolyte abnormalities

furosemide (contraindications)

hypersensitivity, anuria

furosemide (pregnancy)

category C

potassium sparing diuretic (protype)

spironolactone (Aldactone)

spironolactone (route)

PO

spironolactone (onset)

2-3 days, up to 2 weeks for max effect

spironolactone (duration)

2-3 days, half life up to 24 hrs

spironolactone (indications)

mild hypertension, heart failure, nephrotic syndrome, liver disease

spironolactone (mechanism of action)

inhibits action of aldosterone in distal tubule and collecting ducts

spironolactone (adverse effects)

hyperkalemia

spironolactone (contraindications)

hyperkalemia, anuria

spironolactone (pregnancy)

category D

alpha 1 adrenergic antagonist (protype)

prazosin (Minipress)

prazosin (routes)

PO, IV, SQ

prazosin (onset)

2 hrs, varies

prazosin (duration)

less than 24 hours

prazosin (indications)

hypertension, BPH, reynaud’s, pheochromocytoma

prazosin (mechanism of action)

competes with norepinephrine at alpha 1 receptors on vascular smooth muscle

prazosin (adverse effects)

orthostatic hypotension, dizziness, drowsiness, fatigue, 1st dose phenomenon, erectile dysfunction

prazosin (contraindications)

sensitivity

caution: older, renal impairment, CAD

prazosin (pregnancy)

category C

beta adrenergic antagonist (protype)

propranolol (Inderal)

propranolol (route)

PO, IV

propranolol (onset)

PO: 1-2 hrs IV: immediate

propranolol (duration)

3-5 hrs

propranolol (indications)

hypertension, angina, dysrhythmias, migraine, prophylaxis, essential tremor (off label)

propranolol (mechanism of action)

block beta-1 receptors in heart and beta-2 receptors in lungs

propranolol (adverse effects)

bronchospasm, agranulocytosis, stevens-johnson syndrome, bradycardia, fatigue, impotence [rebound tachycardia, myocardial ischemia if abrupt withdrawal]

propranolol (contraindications)

cardiogenic shock, severe heart failure, bradycardia, COPD/asthma, diabetes

propranolol (pregnancy)

category C

beta 1 antagonist (protype)

metoprolol (Lopressor, Toprol)

metoprolol (route)

PO, IV

metoprolol (onset)

PO: 15 min IV: immediate

metoprolol (duration)

13-19 hrs

metoprolol (indications)

hypertension (not 1st line), chronic stable angina, stable heart failure, migraine prophylaxis, essential tremor, atrial dysrhythmias, acute MI

metoprolol (mechanism of action)

selective beta-1 antagonist at receptors in cardiac muscle

metoprolol (adverse effects)

complete heart block, dizziness, fatigue, bradycardia, agranulocytosis, rebound cardiac excitation

metoprolol (contraindications)

cardiac shock, severe bradycardia, heart block

metoprolol (pregnancy)

category C

calcium channel blocker types

dihydropyridines and nondihydropyridines

dihydropyridines (protype)

nifedipine (Adalat, Procardia)

nifedipine (route)

PO

nifedipine (onset)

30-60 min, 6 hr (extended release)

nifedipine (duration)

4-8 hrs, 24 hrs (extended release)

nifedipine (indications)

hypertension, chronic stable angina

nifedipine (mechanism of action)

blocks calcium channels in vascular smooth muscle, including coronary arteries

nifedipine (adverse effects)

hypotension, dizziness, headache, flushing, peripheral edema

nifedipine (contraindications)

hypersensitivity

nifedipine (pregnancy)

category C

nondihydropyridines (protype)

verapamil (Calan, Isoptin, Verelan)

verapamil (route)

PO, IV

verapamil (onset)

PO: 1-2 hrs IV: 1-5 min

verapamil (duration)

PO: 3-7 hrs, 24 hrs (extended release) IV: 2 hrs

verapamil (indications)

antidysrhythmic, hypertension, angina

verapamil (mechanism of action)

inhibits flow of calcium into cardiac muscle and vascular smooth muscle cells

verapamil (adverse effects)

worsening heart failure, bradycardia, reflex tachycardia, AV block, peripheral edema

verapamil (contraindications)

AV block, severe hypotension, SSS

verapamil (pregnancy)

category C