final exams
Module 1
First pass effect: reduces the bioavailability of drug to less than 100%. esp drug absorbed PO. drugs given by IV has 100% bioavailability.
all drug that is absorbed by the intestine must first pass through the liver before it reaches the systemic circulation
Therapeutic index and Dosage range: ratio between the toxic and therapeutic concentration of a drug.
a drug with low therapeutic range have the likelihood of causing adverse reaction therefore need close monitoring. e.g wafarin and digoxin than amoxicillin
Peak and Trough level (Indicated drugs): describes drug concentration. its measured with blood sample.
peak: time required for the drug to reach its maximum therapeutic response. highest blood level
trough: lowest blood level.
if the peak level if too high; this means toxicity.
Sympathetic Nervous System: couterpart of the parasympathetic system. they both make up the autonomic nervous system in which it creates a check and balance system for maintaining the normal homeostasis of the autonomic functions of the human body.
Alpha and Beta receptors
alpha adrenergic agonist response is vasoconstriction and CNS stimulation.
Alpha1 located in the postsynaptic effector cells
Alpha2 located at the presynaptic nerve terminals- control the release of neurotransmitters.
Beta adrenergic agonist response results in bronchial, GI and uterine smooth muscle relaxation; glycogenolysis and cardia stimulation.
Beta adrenergic receptor are located in the postsynaptic effector cells
Beta 1 adrenergic are located primarily in the heart
Beta 2 located in the smooth muscle fibers of the bronchioles, arterioles and viseral organ.
Beta 3: located in the human urothelium muscle and detrusor muscle
Cardiovascular system
Blood vessel- alpha 1- vasoconstriction
beta 2- vasodilation
cardia muscle- beta 1- increases contractility
AVnodes- beta 1- increase HR
SA node- beta1- increase HR
Endocrine
liver- alpha1 and beta 2 -glycogenesis
Kidney- beta 1 - increase renin secretion
Gastrointestinal
muscle- alpha 1 and beta 2-decrease motility
Genitourinary
bladder sphincter- alpha 1- contriction
penis- alpha 1- ejaculation
Uterus- alpha 1- contraction
beta 2- relaxation
adrenergic drugs (catecholamines) : similar to or mimic the effects of the SNS. three neurotransmitter classified as catecholamines are epinephrine, noepinephrine and dopamines. Produce a sympathomimetic response
Catecholamines are produced by the SNS and are stored in the vesicles or granules located in the ends of the nerves
they can either be endogenous which are epinephrine, noepenephrine or dopamine or synthetic substance which is the dobutamineand phenylephrine.
Catecholemines are metabolized by 2 enzymes,es MOA and COMT
MOA breaks down catecholamines at the nerve ending while the COMT breaks it down in the synaptic cleft
Posititve iotropic effect: increase the force of contraction
Positive chronotropic effect: increase HR
Positive dromotropic effect: increase conduction of the cardiac electric nerve impulse through the AV node.
Indication of Adrenergic medication
Respiratory- stimulate the beta2 adrenergic receptor and cause bronchodilation.
Beta 2- located on the bronchial, uterine, and. vascular smooth muscles
treatment og asthma and bronchitis
short acting- albuterol( selective beta dugs
long acting- salmeterol. never used in acute treatment, but used as maintenance treatment of asthma and COPD in conjuction with corticosteroid. not to be given more than 2x a day BID. all LABAs high risk in african american pt.
Contraindicated with pt with uncontrolled HTN, cardiac dysrhythmias, and high risk stroke
Nasal: causes constrition of dilated arteriole and reduce nasal blow flow and decrease congestion.
Ophthalmic- affect the vasculature of the eye. stimulate alpha adrenergic receptor located on the small arterioles in the eye and temporalily relieves conjuctival congestion by causing arteriolar vasoconstriction. used to reduce intraocular pressure- open angle glaucoma
Overactive bladder- relaxes the detrusor muscle during the sttorage phase of the bladder fill cycle which leads to increase bladder capacity
Mybetriq-Beta 3 agonist: - found in the urothelium and detrusor muscles. AE HTN, UTI, headache, nasopharyngitis, Nausea and dizziness.
not to be used with chemotherapeutic agents, silodosin, thioridazine
classified as pregnancy C
decrease efects of tramadol, metoprolol, tamoxifen, and codeine
increases the effect if digoxin, desipramine, ariprazole, colchine and others.
Cardiovascular: support cardiovascular system during cardia failure or shock-vasoactive sympathomimetics and vasoconstrictive drugs
Dobutamine- beta 1 selective.
exogenous catecholamine
with the stimulation of the beta 1 receptor int increase cardiac output by increasing contractility (positive inotrophy) which increases stroke volume in pt with HF.
Dopamine: potent dopamergic as well as beta1 and alpha 1 adrenergic
at a low dose- dilate blood vessels in the brain, heart, kidney and mesentery
at a higher dose it improves cardiac contractility and output also causes vasoconstriction
drug of choice for shock-produce vasoconstriction of the peripheral blood vessel and increase BP. check iv site q1hr cause inflitration cause tissue necrosis
use phentolamine to treat the infiltration.
Used of dopamine is contraindicated with pt with pheochromocytoma
Epinephrine: endogenous vasoactive catecholamine. acts in both beta and and alpha adrenergic agonist. used in many advance cardiac life support protocol. also used to treat acute asthma and anaphylaxis
use of tuberculin syringe may be used to safely administer accuraterately for both adult and children.
in low dose it stimulates the beta adrenergic receptor increasing force contraction and HR.
at high dose it stimulates the alpha adrenergic causing vasoconstriction and elevate BP
Midodrine: prodrug that is converted in the liver to desglymidodrine. the alpha1 stimulation causes constriction of both arterioles and veins resulting in pheripheral vasoconstriction. primary treatment for orthostatic hypotension.
Norepinephrine acts predominantly by directly stimulating the alpha adrenergic receptors that leads to vasoconstriction.
directly metabolized to dopamine and used primarily to treat hypotension and shock
only given by continous infusion
Droxipa- oral noepinephrine that is used to treat neurogenic orthostatic hypotension- risk for supine hypertension. pt should sleep with HOB elevated and 3 hrs prior to bedtime. its associated with neuroleptic malignant syndrome
Phenylephrine- works exclusively on the alpha- adrenergic receptor. used as a short term treatment to raise BP and control dysrhythmias- supraventricular tachycardia
Patients teaching on adrenergic drug
pt on chronic use of sdrenergic drug need to avoid any condition that may exacerbate respiratory condition e.g allergen, cigarette, smoking
implement measures to help diminish risk for respiratory infection- avoid people who have the flu or cold
avoid crowded area
remain well nourished and rested
adequate fluid intake of 3000ml/day
if another type of inhalant is used such as corticosteriod, instruct pt to use the bronchodilator first, with a 5 min in waiting period. all eqipment must be rinsed after use
rinse mouth after using inhaled drug to prevent infection and irritation.
with ophthalmic, do not allow the eye to touch the eye, apply directly to the conjunctive sac
with midodrine increase fluid before pt gets out of the bed, avoid taking medication after 6pm.
do not crush, chew or break mybetriq since its timed released.
Adrenergic blocking drug: interupts stimulation of the SNS. works by direct competition with the noepinephrine or noncompetive process. they have greater affinity to the adrenergic receptor than the noepinephrine. it can chemically displace noepinephrine from the receptor
adrenergic blackage leads to vasodilation decrease Bp,miosis, and reduced smooth muscle tone in the bladder and prostate.
Alpha blockers: doxazosin, prazosin and terazosin- cause arterial and venous dilation the reduces peripheral vascular resistance and BP.
Tamsulosin, alfusozin, and sidosin: the alpha adrenergic receptor in the protate and bladder block the stimulation of alpha1 receptor and reduce the smooth muscle contraction of the bladder neck and prostatic portion of the urethra. given to pt with BPH- to decrease resistance to urinary flow
Indications of alpha blockers
control HTN in pt eith pheochromocytoma
Phenoxybenzamine-beneficial in conditions such as raynaud disease, acrocyanosis, and frostbite
prevent necrosis and slouging after extravasation.
Phentalomine- counter the effects of epinephrine and norepinephrine- peripheral vasodilation and reduce pheripheral resistance
Contraindication: hepatic, renal disease, coronary artery disease, peptic ulcer and sepsis
AE: 1st dose phenomenon- severe and sudden drop of Bp, dizziness, headache, constipation, palpitation, orthostatic hypotension, tachycardia, edema, chest pain, fatigue, numbness, N/V, diarrhea, abd pain, incontinence, dry mouth, pharyngitis.
Interaction: protein bound; competitive with other drugs that are highly protein bound.
Phentalomine- alpha blocker used to treat HTN, treats htn caused by pheochromocytoma and its used to dx catecholamine secresting tumors. treats extravasation of vasoconstrition drugs such as epinephrine, dopamine, and noepinephrine. its injected in a circular fasion around the extravasation site
Contraindication: MI, CAD
AE: tachycardia, dizziness, GI upset
interaction: alcohol - disulfiram like reaction, erectile dysfunction drugs such as sildefil. epinephrine and ephedrine can counter the effect of phetalomine.
Tamsulosin- alpha blocker that is used to treat BPH. indicated for male but can be prescribed for female pt to treat kidney stone. they block alpha adrenergic receptor on the smooth muscle within the prostate and bladder and relax the smooth muscle fibers and improve urinary flow.
Contraindication: concurrent use of erectil dysfuction drugs- hypottensive effects, drugs that induce or inhibit hepatic enzymes
Betablockers: block SNS stimulation of the betaadrenergic receptors by competing with norepinephrine and epinephrine. can be selective or non selective. beta1 adrenergic receptors are located primarily in the heart.
can elevate blood levels of triglyceride and reduce the level of HDL- good cholesterol.
cardiprotective since it inhibits stimution of myocardium by circulating catecholamines
beta blockers that are selective are called cardioseletive or beta1 blocking drugs.
the nonselective beta blockers block both beta 1 and beta 2 and the receptors are primarily located in the smooth muscles of the bronchioles and blood vessels
Cardsioselective beta 1 blockers- block the receptor on the surface of the heart which reduce myocardial stimulation and reduce HR
slow conduction throught he AV node, and prolong SA recovery
decrease myocardial oxygen demand by decreasing the myocardial contractile force
Nonselective beta blocker has both cardiac effect and block beta 2 receptor on the smooth muscle of the bronchioles and blood vessels.
when rhe bronchiles are blocked by beta2 leads to SOB
increase pheripheral resistance
nonselective block glyconolysis and delay recovery from hypoglycemia and mask or blunt the perceptive symptoms
can impede the production insulin from the pancreas causing either hyoglycemia or hyperglycemia
beta2 promote glycogenesis- production of glucose and mobilize glucose in response to hypoglycemia
Indication: angina or chest pain, MI, cardiac dysrhythmias, HTN, and HF. treat irregular heart rhythm called dysrhythmias
since they have lipophilicity- propranolol can gain entry to rthe CNS and are usedin the treatment of migranes and headache
timolol treat ocular disorder such as glaucoma.
Contraindication: cardiogenic shock, heart block, bradycardia, pregnancy, uncompensated heart failure, severe pulmonary disease, Raynaud’s disease
do not abruptly stop, taper over 1-2 wks.- rebound HTN, exacebate angina and precipate MI.
AE: bradycardia, depression, impotence, constipation, fatigue, depression, fatigue, AV block, heart failure, N/V/D and constipation, agranulocytosis, thrombocytopenia, delayed hypoglycemia recovery, masked the symptoms of hyper and hypoglycemia.
Toxicity and management of overdose: atropine for bradycardia, titrate until desired Bp and HR. most beta blocker are dialyze- hemodialysis may be useful in enhancing the elimination in the event of severe overdose.
Interaction: antacids esp the aluminum hydroxide, antimuscarinica, anticholinergics, digoxins, diuretics, cardiovascular drugs, alcohol, neuromuscular blocking drugs , oral hypoglycemic drug and insulin
Atenolol- cardioselective; prevents future heart attack in pt who had one, treatment of HTN and angina, management of thyrotoxicosis- block excessive symptoms of excessive thyriod activity
Carvedilol- non selective, alpha blocker, calcium channel blocker, and antioxidant. primarily ised for treatment of hypertension and angina. it slows rhe progression of heart failure. commonly added with digoxin, lasix and angiotensin converting enzyme inhibitors to treat HF
Esmolol: strong short acting beta1 blocker. used in acute situation to provide rapid temporarily control of the ventricular rate in pt with supraventricular tachycardia. only given by IV.
Labetalol- block both alpha and beta adrenergic receptor. used in the treatment of severe hypertension and hypertension emrgencies to lower BP
metoprolol- common beta1 blocker used. increase the survival rate of pt who recently experienced MI. its a high alert drug.
Propranolol: treatment of tachydysrhythmias associated with cardiac glycoside intoxication and for the treatment of hypertrophic subarctic stenosis, pheochromocyto,a, thyrotoxicosis, headache, essential tremor.
contraindicated with pt wirh bronchial asthma
Sotalol: potent antidysrhythmic. commonly used to manage difficult to treat ddysthmias. class II and class III antidysrhymic drugs. causes hypotension
Cholinergic drugs: stimulate the parasympathetic nervous system- parasympathomimetics as they mimic the effects of acetylcholine.
the desired effects come from muscarinic receptor stimulation and the undesired effect comes from nicotinic receptor stimulation.
Indication: used primarily for their target effect in the GI tract, bladder and eye. it stimulates the intestine, bladder which results in increased gastric secretions, GI motility and urinary frequency, stimulate constriction of the eye, increases salivation, reduced HR and vasodilation, cause constriction in the bronchi of the llungs and narrowing the airway.
direct acting binds dirctly to the cholinergic receptor and activate them
Carbacho;, picarpine, echotiphate- reduce intraocular pressure in pt with glaucoma or those undergoing ocular surgery.
these drugs are poorly absorbed PO so its mainly given topically
Bethanechol: is an exception since its administered orally. it affects the detrusor muscle of the urinary bladder and also the smooth muscle of the GI tract.
also used to treat postoperatively atony of the bladder and GI tract
treat postpartum nonobstructive urinay retention
Contraindication: hyperthyroidism, peptic ulcer, active bronchial asthma, cardia disease or coronary artery disease, epilepsy and Parkinsonism.
Avoided in women that the strength or integrity of their GI tract or bladder is questionable.
AE: syncope, hypotension with reflex tachycardia, headache, seizure, GI upset, and ashmatic attacks
Cevimeline: treats excessive mouth dryness resulting from sjogre syndrome
Succinylcholine: used as a neuromuscular blocker in general anesthesia. structure is similar to that if the parasympathetic neurotransmitter Ach. muscle loss its ability to contract, and flaccid muscle paralysis occurs.
used to facilitate endotracheal intubation since it has a fast onset
Contraindication: personal or familial hx of malignant hyperthermia, skeletal muscle myopathies
indirect acting stimulate the postsynaptic release of acetylcholine to bind to and stimulate the receptor- cholinesterase inhibitors.
reversible inhibitor- binds to cholinesterase for a short period of time
irreversible cholinesterase long duration activity
indirect acting drug increases acetylcholine concentration at the receptor site
they cause skeletal muscle contraction and are used for diagnosis and treatment of myasthenia gravis
they reverse neuromuscular blockage produce by neuromusclar blocking drug or by anticholinergic poisoning.
physostigmine antidote for for anticholinergic poisoning as well as poisoning by irrervisble cholinesterase inhibitors such as organophosphata and carbamates- insecticides.
Indirect acting cholinesterase is used to treat alzhemers- decrease Ach, so cholinergic drug increases the concentration of acetylcholine in the brain by inhibiting cholinesterase
contraindication: GI or GU obstruction, bradycardia, defects in cardiac impulses conduction, hyperthyroidism, epilepsy, hypotension, COPD.
AE: overstimulate the PNS, syncope, bradycardia or tachycardia, hypotension, hypertension, conduction abnormalities, headache, dizziness, convulsions, ataxia, abd cramps, N/V/D, convulsion, increase bronchial secretion, bronchospama, lacrimination, sweating, salivation, miosis.
Toxicity and management: cholinergic crisis-circulatory collapse, hypotension, bloody diarrhea, shock, cardiac arrest. Early signs can be reversed with atropine.
effect of cholinergic poisoning
S- salivation
L- lacrimination
U-urinary incontinence
D- diarrhea
G- GI cramps
E- emesis
Donepezil is an indirect acting drug, which works centrally in the brain to increase the acetycholine by inhibiting acetylcholinesterase.
treats mild to moderate Alzheimer's
AE:Gi upset, ulcer risk and GI bleed, drowsiness, dizziness, insomnia, muscle cramps, bradycardia, syncope, hypotension with reflex taxhycardia or hypertension
interactions: anticholinergic, NSaids
Rivastigmine approve treatment for dementia related to parkinson disease
Pyridostigmine- improve muscle strength and relieve symptoms of myasthenia gravis.
Edrophonium(Tension) indirect acting used to dx myastenia gravis, also used to differenciate myasthenia gravis from cholinergic crisis.
Neostigmine, pyrisostimine and physostigmine- reverse the effect of non depolarizing neuromuscular blocking drugs after surgery.
they also used to treat severe overdoses of TCA
antidote for nondrug anticholinergic agents
Contraindication: KDA, prior or severe cholinergic reaction, asthma, gangrene, hyperthyroidism, cardiovascular disease, mechanical obstruction of GI or GU tract
AE: excessive salivation
interation: anticholinergic
Cholinergic-Blocking Drugs: commonly reverved to anticholinergics. they block the action of the neurotransmitter acetylcholine at the muscarinic receptors in the parasympathetic nervous system. they compete with acetylcholine for binding at the muscarinic receptor in the PNS
major site of action: heart respiratory tract, GI tract, urinary bladder, eye, and exocrine glands
Aropine-antimuscuscaric. increase HR. used to treat bradycardia and ventricular systole.
antidote for anticholinesterase inhibitor toxicity and poisoning
Contraindication: pt with angle close glaucoma, use with caution in pt with hepatic and renal dysfunction, hiatal hernia, reflux esophagitis, intestinal atony, obstructive GI or GU, severe ulcerative colitis.
dicyclomine-synthetic antispasmodic trat functional disturbances of GI motility such as IBS
contraindication: angle close glaucoma,GI tract obstruction, myasthenia gravis, paralytic ileus, GI atony, or toxic megacolon
oxybutynin- sythetic antimuscarinis drug, used to treat overactive bladder. used as a antispasmodic for neurogenic bladder associated with spinal cord injuriesand congenital conditions such a spina bifada
contraindicationurinary or gastric retention, uncontrolled angle close glaucoma
Scopaloamine: most potent used in the prevention of motion sickness. it works by correcting the imbalance between acetycoline and nonepinephrinein the higher center in the brain.
its applied as a transdermal patch behind the ear 4-5 hrs beforetravelling
can use to prevent postoperative post anesthesia N/V. its applied 1 hr before surgery and can be remove 24- 36 hr after surgey
AE: drowsiness,dry mouth, blurred vision
Interaction: alcohol or CNS depressant increases sedation.
Opioid Drugs: pain medication used to manage moderate to severe pain medication.
receptor invloved in pain is the mu, kappa and delta, but the mu is the most cruciial one.visceral and superficial pain can be treated with opiod analgesic.
classified as mild against: codeine and hydrocodone
strong agoinist morphine hydromophone, oxycodone, meperidine, fentanyl, and methadone
opiod also suppress cough- codeine
opiod is originated from poppy seed
an opiod agonist MOAis that it binds to the receptor in the brain and causes an analgesic response.
agonist- antagonist (partial) binds to the brain receptor and causes weaker pain response
antagonist binds to the pain receptor but does not reduce the pain signal but instead competes with and reverse the effect of the agonist and partial agonist.
strong opiod such as morphine, hydrocodone and oxycodone are used to control postoperative type of pain
contraindication: known allergy and severe asthma. morphine cause a pruiritic effect cause of the release of histamine. caution in respiratory insufficiency cases cause it elevates ICP. contraindacated with mobid obesity, paralytic ileus, sleep apnea, mystenia gravis, pregnancy.
AE: constipation, hypotension, flushing, bradycardia, sedation, disorientation, euphoria, lightheadedness, dysphoria, N/V, constipation, bilary tract spasm, urinary retention, itching, rash, when formation, respiratory depression and possible aggravation of asthma.
toxicity and magement of overdose: naloxone is the antidote, naltrexone is used for alcohol and opiod overdose. naloxone is short lived and usually last for 1 hr. it may be redose periodically until the symptoms are resolved
withdrawal of short acting opiod such as codeine, hydrocodone, codeine and hydromorphone appears 6-12 hrs and peak 24- 72 hrs
withdrawal for long half life drug such a s methadone, trandermal fentanyl, and levorphanol may not appear in 24 hr or longer.
interaction: co-administration of opiod with alcohol, antihistamine, barbiturates, benzodiazepines, phenothiazine and other CNS depressant can result in additive respiratory depressant effects.
combination with MOAI such as seligline can result in respiratory depression, seizure and hypotension.
LAB: can increase serum level of amylase, alanine, aminotransferase, alkaline phosphate, bilirubin, lipase, creatinine kinase, and lactate dehydrogenase, decrease urinary 17 ketosteriod levels.
Codeine sulfate: obtain from opium. 10% metabolite to morphine in the body. only opiod with the celling effect- does notincrease response to increased dose. used as a cough suppressant. can be classified as schedule II used in combined with acetaminophen, but schedule II when combined with other drugs.
AE: GI upset
Contraindication: Peds pt, laboring or breast feedinng mothers.
Fentanyl: schedule II. treat moderate to severe. IV form is used in the perioperative setting for sedation during mechanical ventilation. its 0.1mg equivalent to 10mg of mrphine IV.
the patch is used for various chronic pain syndrome such as cancer induced pain. it take 6 - 12 hrs to reach it steady state of pain control and and last for 72 hr. remove old patch before applying new one. it takes 17 hour for amount of fentanyl to be reduced by 50%.
hydromorphone: schedule II. 7x potent to morphine.
oxycodone- oxycontin- is the sustain released oral form. that last up to 12 hr. and prolonged duration is often 8-12 hr
immediate release last 4hrs
meperidine: synthetic opiod anagesic, schedule II. it’s not recommended for long term usage because of accumulation of neurotoxic metabolic. normeperidine which can cause seizure. high risk of toxicity. used with caution in older pt with kidney dysfunction
methadone- opiod choice for detoxification treatment for addicts. eliminated through the liver. may cause cardiac dysrhythmias.
Morphine sulfate: orotype drug and schedule II. indicated for severe pain. has toxic metabolite known as morphine 6 glucuronide. not safe for pt with renal insufficiency.
Oxycodone hydrochloride- analgesic. combined with acetaminophen percocet and aspirin as percodan. the commonly used weaker opiod used is hydrocodone
opiod analgonist-pentazocine and nalbuphine is associated with analgesic celling effect- does not improve the amagesic effect even in higher dosage.
Naloxone: blocking drug for opiods. drug of choice for complete or partial reversal of opiod respiratory depression.
AE: opioid withdrawal syndrome, bp fluctuation, dysrhythmia, pulmonary edema.
Naltrexone is available orally for alcohol and opiod addiction
Nonopioid Analgesic: Nonsteroidal Antinflammatory Drugs, somatic pain is treated with nonopiod such as NSAIDs. used in the management of pain especially pain associated with anti inflammation condition such as arthritis.
Acetaminophen: block pheripheral pain impulses by inhibiting the prostagladin synthesis. it lowers body temperature. treatment of mild to moderate pain and fever. drug of choice for children and adolescent with flu syndrome
Contraindication: severe liver disease, and genetic disease known as glucose-6-phosphate dehydrogenase deficiency.
AE: skin disorder; anemia, N/V, nephrotocities, and hepatotoxicity.
FDA recommend 4000 mg limit per day., but manufacturer suggest 3000 mg/day and 2000 for pt eith liver disease. or alcohol consumption.
Management: acetylcysteine is the antidote. it has an odor of rotten egg. if pt vomit within 1hr of dosing. it is recommended to repeat treatment.
interaction: alcohol, phenytoin, barbiturates, wafarin, isoniazid, rifampin, betablockers, and anticholinergic drugs.
Aspirin associated with Reye’s syndrome
Tramadol: miscellaneous analgesic. centrally acting with dual MOA. It creates a weak bond to the mu opioid receptors and inhibits the reuptake of both norepinephrine and serotonin
lidocaine, transdermal: It is indicated for the treatment of postherpetic neuralgia, a painful skin condition that remains after a skin outbreak of shingles
The patches are not to be worn for longer than 12 hours a day to avoid potential systemic drug toxicity (e.g., cardiac dysrhythmias).
COX 2 Inhibitors,
Antiepileptic Drugs
Dopamine Replacement Drugs
Anticholinergic Drugs
Anxiolytic Drugs.
Module 2
Alpha vs Beta Blockers,
Calcium Channel Blockers,
ACE/ARB:
Diuretic,
Antianginal drugs,
Nitrates/nitrites,
Antidysrhythmic drugs,
Anticoagulant drugs,
Warfarin/Heparin,
ASA,
Lovenox.
Antilipidemic drug,
statins Fluids drugs,
Electrolyte Level.
Module 3
Antihistamines:
Antitussive: Expectorant,
Bronchodilators: Epinephrine,
Anticholinergics: Xanthine Derivatives:
Leukotriene Receptor Antagonists,
Corticosteroid,
Sulfonamides,
Beta-lactam antibiotics
Cephalosporins,
Macrolides,
Quinolones,
Antimicrobials,
Module 4
Muscle relaxants drug,
Benzodiazepines,
Thyroid drugs,
Diabetes Drug,
Sulfa,
Metformin,
Insulin Short vs long acting,
PPI,
Anticholinergic,
Antiemetic.
Module 5
Estrogens,
Progestin,
Medroxyprogesterone (Provera, Depo-Provera),
Contraceptive Drugs,
Osteoporosis – Bisphosphonates,
Selective estrogen receptor modulators,
Uterine Stimulants,
Oxytocin,
5-Alpha Reductase Inhibitors Alpha1Adrenergic Blockers,
Drugs for Erectile Dysfunction.